COVID-19 screening formQ1. Have you travelled outside of the country in the last 14 days? 在过去的14天内您是否刚从国外回来？Adakah anda baru berpulang dari luar negara?*YesNoQ2. Did you attend any event associated with known COVID-19 outbreak? 您是否曾经出席任何活动（有确诊Covid-19病患一并出席）？ Adakah anda pernah menghadiri majlis-majlis di mana terdapat kes Covid-19 yang sudah dikesan?*YesNoQ3. Did you have any *close contact with confirmed COVID-19 patient? 您有没有近距离接触任何确诊Covid-19的病患？ Adakah anda ada hubungan rapat dengan pekasit yang dikenalpasti Covid-19?*YesNo*close contact defined as : - Health care associated exposure without appropriate PPE (including providing direct care for COVID-19 patients, working with health care workers infected with COVID-19, visiting patients or staying in the same close environment of a COVID-19 patient). - Working together in close proximity or sharing the same classroom environment with a with COVID-19 patient. - Traveling together with COVID-19 patient in any kind of conveyance. - Living in the same household as a COVID-19 patient 近距离接触意味着：- 医疗接触并没有佩戴适当的保护装备（包括了照顾Covid-19病患，与确诊Covid-19的医疗业的同事一起工作，探访病人或在一个封闭空间与确诊Covid-19的病患相处）- 与确诊Covid-19的病患一同工作，或是在一个课室般的环境相处 – 与确诊Covid-19的病患一同旅行 – 与确诊Covid-19的病患一同居住Hubungan rapat bermaksud:－sebagai pegawai sektor kesihatan dan tidak memakai PPE yang lengkap ( Termasuk menjaga pesakit Covid-19, bekerja dengan staf-staf yang dijangkit Covid-19, melawat pesakit Covid-19 ) – bekerja di kawasan sama dengan pesakit Covid-19, atau berada di dalam bilik yang sama dengan pesakit Covid-19 – bersama-sama melancong / tinggal dengan pesakit covid-19Q4. Are you on home quarantine as advised by Pejabat Kesihatan Daerah (PKD)? 您是否正在卫生部的指令下进行隔离？ Adakah anda dalam tempoh kuarantin seperti yang dipesan oleh PKD ( Pejabat Kesihatan Daerah) ?*YesNoQ5. Do you have FEVER (>37.5'C)? 您是否有发烧？（体温超过37.5C） Adakah anda demam (suhu badan > 37.5C) ?*YesNoQ6. Do you have COUGH? 您是否有咳嗽？ Adakah tanda-tanda seperti batuk?*YesNoQ7. Do you have SORE THROAT? 您是否有喉咙痛？ Sakit tekak?*YesNoQ8. Do you experience SHORTNESS of BREATH? 您是否有呼吸困难？ Sesak nafas?*YesNoSorry! We are unable to proceed further for the COVID-19 test request as compliance to MOH guidance and policy which states: “Individuals that does not meet the above criteria is not allowed to opt for the COVID-19 at private facilities".SendThis field should be left blank