Asthma, reactive airway, or
other chronic respiratory
disease that requires daily
medication for control
65 years of age or older
Chills, with
repeated
shaking
• Shortness of breath, even when you are not exerting yourself
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• Confusion/unresponsiveness
Muscle pain
• Eye problems, such as watery eyes or swollen eyelids
• Chest discomfort
I don't have any of these medical conditions or characteristics
• Trouble staying awake
• Tracheostomy
• Gastrostomy
• Positive-pressure
ventilation not
related to COVID-19
Gastrointestinal
upset, including
vomiting and
diarrhea
• Bluish face/lips (a sign that you are not getting enough oxygen)
I have at least one of these medical conditions or characteristics
Fatigue
I don’t have any of these symptoms
Cardiovascular
disease
Deep cough
Chronic obstructive
pulmonary disease or other
chronic respiratory disease
General
feeling of
being unwell
Fever
New loss of
taste or smell
A healthcare provider
told you that you are
overweight for your
age and height
Hypertension
Medical-related technological
dependence:
Body mass index (BMI)
greater than 35
Dry cough
These do not apply to me
Body aches
Neurodevelopmental
disorders, for example,
cerebral palsy
Chronic kidney disease
Itchy, painful
patches on skin.
These often show
up on the toes and
are referred to as
‘COVID toes’
Sickle cell disease
Immunosuppressive
disease
Congenital or acquired
heart disease
Diabetes
Headache
I have at least one of these symptoms
Neurodevelopmental disorders,
for example,cerebral palsy
Body mass index (BMI) greater
than 35
Gastrointestinal upset,
including vomiting and diarrhea
General feeling of being unwell
Itchy, painful patches on skin.
These often show up on the toes
and are referred to as ‘COVID toes’
New loss of taste or smell
Chills, with repeated shaking
Immunosuppressive disease
• Bluish face/lips (a sign that you
are not getting enough oxygen)
I don’t have any of these medical conditions or characteristics
Asthma, reactive airway, or other
chronic respiratory disease tha
requires daily medication for control
• Shortness of breath, even when
you are not exerting yourself
Currently receiving
immunosuppressive treatment
• Tracheostomy
• Gastrostomy
Chronic obstructive
pulmonary disease
or other chronic
respiratory disease
A healthcare provider told you that yo
are overweight for your age and height
Medical-related technological dependence:
• Eye problems, such as watery
eyes or swollen eyelids
• Positive-pressure ventilation
not related to COVID-19
Congenital or acquired heart disease