Jose R. Reyes Memorial Medical Center Health Declaration Form










Fever (Lagnat) (greater than or equal to 37.6°C) Cough (Ubo)
Colds (Sipon) Muscle and body pains (Pananakit ng katawan)
Sore Throat (Pananakit ng lalamunan) Shortness of breath (Kinakapos sa paghinga)
Difficulty of breathing (Hirap sa paghinga) Diarrhea (Pagtatae)
Decreased sense of smell (Problema sa pag-amoy) Decreased sense of taste (Problema sa panlasa)