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COVID-19 SCREENING & CONSENT FORM Prior to clinic facetoface appointmentKEEPING US SAFE Do you currently have a suspected or diagnosed case of COVID-19? Do you currently have any symptoms of COVID-19?
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Wash your hands frequently with soap and water, or use alcohol-based hand sanitizer.
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Coronavirus - hseie is a form used by the healthcare sector to report cases of coronavirus.
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The purpose of coronavirus - hseie is to track and monitor cases of coronavirus for public health reasons.
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Information such as patient demographics, symptoms, test results, and potential exposures must be reported on coronavirus - hseie.
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