COVID-19 Medical Patient Screening & Consent

Medical clinics can use this detailed yet concise form to screen patients for COVID-19 as well as collect their consent for treatment. Patients can complete the form online, whether on a computer, laptop, tablet, or mobile phone. Clinics may also distribute their own tablets to patients for completing the form once a pre-screening has been conducted over the phone. In addition to eight screening questions, the form includes eight boxes patients must check before signing the form. The digital form includes smart functionality to ask further questions if the patient has tested positive, including when and if they have since been confirmed negative and when and how such tests were completed.