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Covid-19 screening protocol

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COVID-19 SCREENING

  1. Have you had any of the following symptoms in the past week?

 

  • Fever                                    
  • Cough
  • Difficulty breathing
  • Sinus congestion/ stuffy nose
  • Sore throat
  • Runny nose
  • Shortness of breath
  • Wheezing or chest tightness
  • Sneezing

 

If NO SYMPTOMS -> STOP – no further action required. Patient may come into clinic

If Yes, they HAVE SYMPTOMS - > Move on to Question 2.

  1. Have you traveled to of from any of the countries listed below in the past 14 days and/or had close contact with a person who is under investigation for Covid-19?

 

  • China
  • South Korea
  • Iran
  • Italy
  • Japan

 

If No to Question 2 - > STOP – No further action required. Patient may come into clinic under droplet precautions

If yes to Question 2, complete the following steps:

  • Ø Complete Secondary Screening Questions on Page 2
  • Ø Contact your County Health Department (see Page 3)

COVID-19 Secondary Screening Questions

  • ü Complete a separate form for each patient, caregiver or family member who is screened
  • Date of Questionnaire: _____ / _____ / _____
    Patient Name: ___________________________________________________________________
    Patient MRN: ____________________________________________________________________
    Patient Contact Information: _______________________________________________________
    Staff Member completing Questionnaire: _____________________________________________
    Staff Member contact information: __________________________________________________

If phone interpreter is desired, see attached list from Language Scientific, Language Phone Interpreting

Service utilized by California Specialty     

Pharmacy

Date of symptom onset ____ / ____ / _____

Does the patient have the following signs and symptoms (check all that apply)?

  Fever                Cough              Sore throat                Shortness of breath

     In the 14 days before symptoms, did the patient:

Spend time in any of the following locations:
 China  South Korea  Iran  Italy  Japan
What area/city (list all) ______________________________________
Does the patient live in country above?  Yes  No  Unknown
Date traveled to ____ / ____ / _____
Date traveled from ____ / ____ / ____
Date arrived in US ____ / ____ / ____

          

Have close contact * with a person who is under investigation for COVID-19 while that person was ill?  Yes  No  Unknown

Have close contact * with a laboratory-confirmed COVID-19 case while that person was ill?  Yes  No  Unknown

*Close contact is defined as: a) being within approximately 6 feet (2 meters) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection); or b) having direct contact with infectious secretions (e.g., being coughed on) while not wearing recommended personal protective equipment. Data to inform the definition of close contact are limited. At this time, brief interactions, such as walking by a person, are considered low risk and do not constitute close contact

COVID-19 Clinical Staff Instructions

Patient’s Interview Questions

Instructions for Staff

If the patient has:

Fever or symptoms of lower respiratory illness (e.g. cough, difficulty breathing)

-         AND - 

In the last 14 days before symptom onset, a history of travel from China, South Korea, Iran, Italy, or Japan

-         OR –

In the last 14 days before symptom onset, close contact with a person who is under investigation for COVID-19 while that person was ill.

Notify County Health Department:

 

Los Angeles County DPH Acute Communicable Disease Control:

• Weekdays 8:30am–5pm: call 213-240-7941.

• After-hours: call 213-974-1234 and ask for the physician on call.

Orange County Public Health

·        714-834-8180

Riverside County Public Health

·        951-358-5000

San Bernardino County Public Health

·        (800) 722-4777

·        After Hours: (909) 356-3805

Ventura Public Health

·        805-981-5201

If the patient has:

Fever or symptoms of lower respiratory illness (e.g. cough, difficulty breathing, but no relevant travel history or ill close contact

   Droplet precautions for respiratory symptoms (goggles or face shield)

If the patient has:

Travel history to China, South Korea, Iran, Italy, or Japan within the past 14 days or close contact* with a person who is under investigation for COVID-19 while that person was ill, but no symptoms

   Standard precautions

*Close contact is defined as: a) being within approximately 6 feet (2 meters) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., gowns, gloves, respirator, eye protection); or b) having direct contact with infectious secretions (e.g., being coughed on) while not wearing recommended personal protective equipment. Data to inform the definition of close contact are limited. At this time, brief interactions, such as walking by a person, are considered low risk and do not constitute close contact

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