Temperature Form First Name(Required)Last Name(Required)Temperature in Fahrenheit(Required)Position(Required)– Select Position –OtherAccountantAccounting ClerkAssociate Chief – Clinical OperationsAssociate Chief of Clinical System ManagementCall Center RepresentativeCall Center SupervisorChief Executive Officer / PresidentChief Financial OfficerChief Medical OfficerChief Operations OfficerClinical CoordinatorClinical InformaticistClinical TherapistCommunity Health WorkerCommunity Health Worker-Clinical/OutreachControllerDental AssistantDental CoordinatorDental HygienistDentistDirector – DentalDirector – Information TechnologyDirector – Quality Improvement/Risk/AccreditationDirector- Behavioral HealthDirector- Human ResourcesDirector Of Clinical ServicesExecutive AssistantHR AssistantHR GeneralistInformation Technology Support TechnicianInformation Technology Systems AdministratorLead Medical AssistantLicensed Practical NurseMedical AssistantMedical Records ClerkNurse PractitionerPatient Registration SpecialistPatient Registration Specialist – MedicalPatient Registration Specialist- Dental ClinicPharmacist In ChargePharmacy TechnicianPhlebotomistPhysician – Family MedicinePhysician – OB/GYNPhysician AssistantPractice ManagerQuality Improvement CoordinatorRevenue Cycle AnalystRevenue Cycle ManagerRn Care ManagerSr. AccountantSr. Revenue Cycle AnalystStaff PharmacistSubstance Abuse TherapistLocation(Required)– Select Location –15400 W McNichols Rd, Detroit MI 482354669 E 8 Mile Rd, Warren, MI 4809160 E Warren Avenue, Detroit, MI 48201355 Oakman Blvd, Detroit MI 48238100 Talon Centre Bldg., Ste. 450, Detroit, MI 48207To the best of your knowledge have you been in close proximity to any individual who tested positive for COVID-19?(Required) Yes No Have you or anyone in your household had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, fever at or greater than 100 degrees Fahrenheit?(Required) Yes No Do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19?(Required) Yes No
