TEST SERVER
Items marked with (
*
) are required
Clinical Criteria
1.
*
Do you or the patient have a cough?
Yes
No
2.
*
Do you or the patient have shortness of breath?
Yes
No
3.
*
Do you or the patient have a sore throat?
Yes
No
4.
*
Do you (or the patient) have loss of sense of smell?
Yes
No
5.
*
Do you (or the patient) have alteration of the sense of taste?
Yes
No
6.
*
Do you or the patient have a high fever?
Yes
No
7.
*
Do you (or the patient) experience weakness?
Yes
No
8.
*
Do you (or the patient) have muscle pain?
Yes
No
9.
*
Do you (or the patient) have diarrhoea?
Yes
No
Close contact
10.
*
Did you (or the patient) have close contact with a confirmed COVID-19 case in the past 10 days?
Yes
No
11.
*
Have you (or the patient) been a resident or a staff member, in a residential institution for vulnerable people where ongoing COVID-19 transmission has been confirmed, in the past 10 days?
Yes
No
Please note this is an unmonitored self-assessment tool
Submit Assessment
