Covid-19 pre-appointment questionnaire

This page explains the content and coding for the Covid-19 pre-appointment questionnaire.

On this page:

1. Questionnaire content
2. Codes to the medical record
3. How to give feedback

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.

 

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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.