| Record ID | Event Name | Repeat Instrument | Repeat Instance | First Name | Last Name | Phone Number | ZIP Code | Date of birth | Age (years) | Ethnicity | Race | Gender | Complete?...14 | Have you experienced any new symptoms of COVID-19? | When did your symptoms start? | Which of the following symptoms have you experienced? (choice=Sore Throat) | Which of the following symptoms have you experienced? (choice=Cough) | Which of the following symptoms have you experienced? (choice=Shortness of Breath) | Which of the following symptoms have you experienced? (choice=Chest Pain) | Which of the following symptoms have you experienced? (choice=Headache) | Which of the following symptoms have you experienced? (choice=Runny Nose) | Which of the following symptoms have you experienced? (choice=Congestion) | Which of the following symptoms have you experienced? (choice=Fever) | Which of the following symptoms have you experienced? (choice=Body Aches) | Which of the following symptoms have you experienced? (choice=Nausea/Vomiting) | Which of the following symptoms have you experienced? (choice=Diarrhea) | Is there any other symptom you'd like to report or anything you would like us to know about your symptoms? | Complete?...29 | Have you recently taken a test for COVID-19? | Did you test positive for COVID-19? | When did you test positive for COVID-19? Use the first positive test date if you tested more than once. | Upload your test results here (optional): | Have you had COVID-19 before? | When did you test positive for COVID-19 when you had it previously? (Ok to estimate.) | Complete?...36 | Name of close contact | What day were you last in contact with this person? | Phone number of close contact | Email of close contact | Complete?...41 | Supervisor Name | Supervisor email | Do you ever work in-person? | Date you last worked in-person? | Was this person at work while contagious? Symptom Onset Date: [case_intake_arm_1][symptom_onset] | Was this person at work while contagious? | Complete?...48 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Personal Info | NA | NA | John | Doe | (999) 999-9999 | 98105 | 2006-04-11 | 18 | NOT Hispanic or Latino | White | Male | Complete | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| 1 | Notifications | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | Boss | NA | No | NA | No | NA | Complete |
| 1 | Case Intake | NA | 1 | NA | NA | NA | NA | NA | NA | NA | NA | NA | Incomplete | Yes | 2023-10-09 | Checked | Checked | Unchecked | Unchecked | Unchecked | Unchecked | Checked | Unchecked | Unchecked | Unchecked | Unchecked | NA | Complete | Yes | Yes | 2023-10-10 | test_api_export_image.png | No | NA | Complete | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| 1 | Notifications | Close Contacts | 1 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | Jane Doe | 2023-10-09 | (999) 999-9999 | fake_email@gmail.com | Complete | NA | NA | NA | NA | NA | NA | NA |
| 1 | Notifications | Close Contacts | 2 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | Johnny Appleseed | 2023-10-08 | (999) 999-9999 | fake_email@gmail.com | Complete | NA | NA | NA | NA | NA | NA | NA |
| 2 | Personal Info | NA | NA | Jane | Doe | (999) 999-9999 | 98105 | 1994-06-29 | 29 | Hispanic or Latino | More Than One Race | Female | Complete | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |