Infectious Disease Screening Questionnaire
The following is the Infectious Disease Screen Questionnaire. All visitors who enter the SCOI building need to complete the Infectious Disease Screening form and have their temperature taken upon entry. Please understand this screening is being done for the safety of our patients and our staff.
Have you been diagnosed with COVID-19 or been advised/directed to begin testing/ monitoring/quarantine for COVID-19 in the last 14 days? Yes/No
Has someone in your household, or someone with whom you have been in close contact, been advised/directed to begin testing/monitoring/quarantine for COVID-19 in the last 14 days? Yes/No
Are you OR anyone you are in close contact with currently experiencing ANY of the following symptoms in the past 14 days?
- Fever (greater than 38.0°C or 100.4°F) Yes/No
- Severe headache Yes/No
- Diarrhea/Vomiting/Abdominal Pain Yes/No
- Respiratory illness Yes/No
- New or worsening cough Yes/No
- Sore throat Yes/No
- Shortness of breath Yes/No
- Loss of smell Yes/No
- Loss of taste Yes/No
- Unexplained hemorrhage (bleeding or bruising) Yes/No
- Fatigue Yes/No
- Generalized muscle aches, weakness or skin changes Yes/No
If you answered "Yes" to any of these questions and you may request a video visit with your doctor. Learn more about SCOI's telemedicine options now.
SCOI COVID-19 Visitor Policy
In order to control the number of people in our SCOI areas and minimize exposure and to be able to comply with physical distancing, any SCOI patient is not allowed to bring a visitor with them into any SCOI facility unless they require a caregiver or assistant due to disability or unless they are under age 18 and require an adult. In these instances, only one visitor is allowed. Anyone else is unnecessary and can be communicated with via telephone/email/telehealth. Any other visitors that accompany the patient will be instructed to wait outside our facilities or in their vehicles. All visitors who enter the SCOI building need to complete the Infectious Disease Screening form and have their temperature taken upon entry.