| Questions | Answers |
|---|---|
| Do you smoke? | |
| Do you have chronic heart disease? | |
| Do you have diabetes? | |
| Do you have lung disease? | |
| Are you older than 64 years? | |
| Have you missed any routine healthcare appointments? | |
| Do you have a compromised immune system? (This could be due to HIV, cancer, or malnutrition, among others). |