Screening Questions During COVID-19



1. Have you, your child, or a family member been diagnosed with COVID-19? If yes, STOP: Patients or family members who are have diagnosed with and currently have COVID-19 will not be seen until cleared with a negative test or have been quarantined for at least 2 weeks.				No ____
2. Are you/they in contact with any confirmed COVID-19 positive patients? Patients who are well but who have a sick family member at home with COVID-19 will need to postpone elective treatment.				No ____
3. Do you/they have fever or have you/they felt hot or feverish recently (14 days)?				No ____
4. Are you/they having shortness of breath or other breathing difficulties?				No ____
5. Do you/they have a cough?				No ____
6. Any other flu-like symptoms, such as gastrointestinal upset, headache, or fatigue?				No ____
7. Have you/they experienced recent loss of taste or smell?				No ____
8. Do you/they have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorders?				No ____
				No ____

Serving The Following Locations:
Warren • Howland • Cortland • Boardman/Canfield • Youngstown • Sharon PA