COVID-19 patient questionnaire Hospital Saint-Louis You are a patient, you have an appointment at the hospital for a consultation or a hospitalisation. With the help of this COVID-19 symptoms questionnaire, please check that you don’t have any symptoms of...
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COVID-19 patient questionnaire Hospital Saint-Louis You are a patient, you have an appointment at the hospital for a consultation or a hospitalisation. With the help of this COVID-19 symptoms questionnaire, please check that you don’t have any symptoms of COVID-19 and please state if you have been in contact with people who are possibly ill. You are going to be hospitalised: You will be contacted before you come to the hospital and we will ask you these questions. You have a hospital appointment: You must complete the questionnaire below, the day before you come. Please circle the correct response if you have today or if you have had in the last 48 hours one of the following signs or symptoms: Fever – Temperature >38° Yes No Headaches Yes No Shivers Yes No Body aches, stiffness Yes No Heavy sweating, perspiration Yes No Extreme tiredness Yes No A cold Yes No Coughing Yes No A sore throat Yes No Diarrhoea, nausea, abdominal pains Yes No Loss of a sense, of taste and or smell Yes No Skin
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