This page explains the content and coding for the Covid-19 pre-appointment questionnaire.
To learn more about questionnaires, see the what are questionnaires help page or the how to send a questionnaire guide.
On this page:
Questionnaire content
Text message - invite
Dear <patient first name>,
<Practice name> would like to ask a few questions about your health before your appointment.
This will make sure it's safe for you to attend, and help to stop the spread of Covid-19.
It should take about 2 minutes, and your answers are private.
Select the link to get started <link>
Introduction screen
Covid-19 questionnaire before your appointment
Dear <Patient name>,
<Practice name> would like to ask a few questions about your health before your appointment. This will make sure it's safe for you to attend, and help to stop the spread of Covid-19.
It should take about 2 minutes, and your answers are private.
Thank you,
<Practice Name>
Questions and answers
1.
Do you have a high temperature or fever?
If you feel hot on your chest or back, please answer yes. Or if you have a thermometer, a high temperature is anything above 37.8 degrees.
- Yes
- No
2.
Do you have a new, continuous cough?
This could be a cough you've not had before, or an existing cough that has got worse.
Continuous means coughing for more than an hour, or 3 or more coughing episodes in 24 hours.
- Yes
- No
3.
In the last 2 weeks, have you had a loss or change to your sense of smell or taste?
- Yes
- No
4.
When did your symptoms start?
If you do not know the exact date, try to be as accurate as you can.
- Day, Month, Year input
5.
In the last 2 weeks, has anyone in your household had a high temperature or a new continuous cough?
- Yes
- No
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Check and submit answers
Please check your answers are correct before sending them to your GP practice.
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Your results
You can go to your appointment as arranged
You do not have any of the officially recognised symptoms of Covid-19.
We’ve sent your answers to your GP - thank you.
---
Your results
Do not go to your appointment
Please do not go to your appointment as you may have Covid-19.
Your GP practice will contact you as soon as possible. They will advise you on what to do next.
To help keep yourself and others safe, you should stay at home and self-isolate immediately. For more information, please read the NHS coronavirus advice.
Response sent to the MJOG inbox
Inbox subject line
Passed/Failed COVID-19 pre-appointment screening
Inbox contents
Questionnaire: COVID-19 pre-appointment screening (questionnaire version 1)
Fever: Yes/No
Cough: Yes/No
Change in smell or taste: Yes/No
When did symptoms start: DD-MMM-YYYY
Household with symptoms: Yes/No
Codes to the medical record
If fails COVID-19 pre-appointment screening
Suspected coronavirus disease 19 caused by Severe acute respiratory syndrome coronavirus 2 (situation)
SNOMED: 1240761000000102
Read: Y20cf
Comment: Patient failed Covid-19 pre-appointment screening (questionnaire version 1)
If passes COVID-19 pre-appointment screening
Patient condition assessed (procedure)
SNOMED: 398214005
Read: XUYW9
Comment : Patient passed Covid-19 pre-appointment screening (questionnaire version 1)
How to give feedback
As always, we’d love to hear your feedback about our questionnaires.
To request a new questionnaire or suggest changes, please fill in our request form.