1. Do you have any of the following new or worsening symptoms or signs?
* New or worsening cough Yes No
* Shortness of breath Yes No
* Sore throat Yes No
* Runny nose, sneezing or nasal congestion (in absence of underlying reasons
for symptoms such as seasonal allergies and post nasal drip) Yes No
* Hoarse voice Yes No
* Difficulty swallowing Yes No
* New smell or taste disorder(s) Yes No
* Nausea/vomiting, diarrhea, abdominal pain Yes No
* Unexplained fatigue/malaise Yes No
* Chills Yes No
* Headache Yes No
2. Do you have a fever? Yes No
3. Have you had close contact with anyone with respiratory illness or a confirmed or probable case of COVID-19? Yes – go to question 5 No – screening complete 5.
4. Did you wear the required and/or recommended PPE according to the type of duties you were performing (e.g., goggles, gloves, mask and gown or N95 with aerosol generating medical procedures (AGMPs)) when you had close contact with a suspected or confirmed case of COVID-19? Yes No
Patients are required to read and acknowledge the above and email us back with the following: ” I HAVE READ AND ACKNOWLEDGE THAT I DO NOT HAVE ANY OF THE SYMPTOMS LISTED ” If you answer YES to any of the screening questions, you must wait 14 days until your visit.
Other public health precautions at the clinic include:
– A plexiglass barrier will be in place around the reception desk.
– Hand sanitizer will be made available for patients.
– Patients are required to wear […]
