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COVID-19 PANDEMIC
PATIENT DISCLOSURESThis paint disclosure form seeks information from you that we must consider before making treatment decisions in the
circumstance of the COVID-19 virus.
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Read the instructions provided at the beginning of the form.
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Provide your personal information such as name, age, gender, and contact details.
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Answer the questions regarding your symptoms, if any.
06
Provide details about any travel history or potential exposure to Covid-19.
07
Answer additional questions related to your medical history and pre-existing conditions.
08
Review the information provided and make any necessary corrections.
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Submit the form electronically by clicking on the submit button.
10
Wait for further instructions or contact from the relevant health authorities regarding your covid-19 status.
Who needs covid-19 pandemic - patient?
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Anyone who suspects they have been infected with or exposed to Covid-19 needs to fill out the covid-19 pandemic - patient form.
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Filling out the form helps health authorities assess the individual's risk level and provide necessary guidance or medical assistance.
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