Important information

Do you or someone close to you have Initial flu-like symptoms, such as fever, coughing, trouble breathing, fatigue, and myalgia (muscle pains)
Are you ill or worried that a close contact (such as a family member, roommate, close coworker, etc) might have a Covid 19 infection?
Health care providers are currently under exceptional pressure and it may be difficult for you to access and communicate with them efficiently.
This tool is designed to help you stay calm and communicate efficiently by summarizing the important information you need to share with your health care provider, in person or remotely.
It takes 5 mins to complete. At the end you will be able to download and print a summary document for your health professional.

fievre
Fever
toux
Cough

The answers to the questionnaire Covid-Quest will be summarized in a document you can share for a medical consultation.
It will also provide you with personalized advice for your stated health situation. It can be completed by you or someone who is helping you.
This tool is NOT meant to replace a medical evaluation and diagnosis. It is meant to facilitate the dialogue with your health care provider and if necessary can be shared with other doctors or providers. Covid-Quest is meant to be used by adults (> 20 years old).
Covid-Quest is designed by doctors and health professionals with the SPLF (Société de pneumologie de langue française), self-measurement.com and automesure.com
tellittogether
SPLF
Question 1 sur 26 About you
How old are you?






Do you live in an institution or retirement home?


Do you live alone?

Consider calling your relatives and people around you so you don’t lack medication, food or physical assistance if your state worsens.

Do you smoke?

Tobacco consumption can accelerate the process of the coronavirus infection

Have you been in contact with a person tested positive to coronavirus?



toux
Do you have a (new) cough?

If yes, since when ?




fievre
Do you have fever ?

If yes, since when ?




thermometre
What is your current temperature?




You have temperature greater than 98.6F (100.1 low grade?). As you are waiting for a doctor, drink fluids, especially if you are elderly.

You have temperature greater than 98.6F (100.1 low grade?). As you are waiting for a doctor, drink fluids, especially if you are elderly.
Do you have a runny nose ?



Do you have pain?

If yes : where?


Do you have trouble breathing ?

If yes, I have high difficulty breathing and you are in pain call an emergency service If yes, I have high difficulty breathing but NO pain: Call for an emergency appointment with a doctor. telephone

If you are currently treated for a chronic respiratory disease, ask your doctor if you should adapt your treatment

If you are currently treated for a chronic respiratory disease, ask your doctor if you should adapt your treatment


Have you even temporarily lost your sense of smell (anosmia) ?

However it is not a sign of worsening physical condition. You should mention it to your doctor. Do not treat it with corticoids, inhaled or swallowed. Be mindful that clearing your nose will help the virus dissemination, avoid it if you can.

Have you even temporarily lost your sense of taste?

However it is not a sign of worsening physical condition. You should mention it to your doctor. Do not treat it with corticoids, inhaled or swallowed. Be mindful that clearing your nose will help the virus dissemination, avoid it if you can.

Do you have other symptoms ?








You feel confusion or dizziness. Call for an emergency appointment with a doctor telephone

You feel confusion or dizziness. Call for an emergency appointment with a doctor telephone
Have you been diagnosed with a chronic lung/respiratory disease?

If yes, which one?









If you have a chronic lung/respiratory disease, have increased your treatment (inhaled treatment, oxygen etc.?

If you do not feel better after increasing your treatment call your doctor immediately telephone

medicament
Currently are you treated for any other Chronic diseases ?

If yes, which one?


Know that acetaminophen at high dose can be toxic for the liver. Check your specialist or your document if you can take acetaminophen.

Diabetes can make you even weaker in case of infection don’t hesitate to call your doctor Diabetes puts you at greater risk of infection, speak to your doctor.

You should drink a lot. Fever can lower your blood pressure and antihypertensives treatment can be temporary suspended. Self measure your blood pressure often. Check blood pressure and take the average of three measures. Definiton of hypertension is BP >than 130 systolic and >80 diastolic (double check this new guideline it used to be 140/90) automesure






seringue
Have you been vaccinated against the flu this year?

medicament
Are you taking Antibiotics for respiratory symptoms. Definition of respiratory is ear/nose/throat/sinus/lungs

If yes, which one ?
Since when do you take them?:

If you have been taking antibiotics for respiratory symptoms for more than 3 days Antibiotics are NOT effective in case of viruses, but may be used if a bacterial infection develops (ie. superinfection). If taking antibiotics, ask your doctor how long to continue. Antiviral treatments are NOT available against COVID19, however, if you are on an antiviral for other viral illness, speak to your doctor.
Do you take NSAIDS type, ibuprofèn?

It has been observed that the use of NSAIDS can increases risk of Respiratory distress if you have or potentially have Covid19 NSAIDS are prohibited medicament
Do you take Cortisone ?

Patients on immunosuppressive treatment for chronic illness should NOT stop until speaking with their doctor medicament
Do you take acetaminophen ?

Acetaminophen is effective to reduce fever and pain and doesn’t increase risk. medicament
Do you take aspirin ?

automesure
Respiration frequency Please indicate your respiration per minutes.



You checked more than 22 per minute, this means it is an event justified to contact a doctor or emergency service telephone
To be more precise, you can add the number of respiration per minute here.
oxymetre
Oxygen level
If you monitor oxygen saturation levels please indicate here:



You checked less than 90%: this is a low value which justifies contacting a doctor or an emergency service. telephone
tensio Hypertension
If you measure your blood pressure, please select the average of three consecutive measurements. Allow 1 min of rest between each measurement.

You checked less than 80: this is a low value which justifies contacting a doctor or an emergency service without delay. telephone

You checked between 80 and 90: this is a low value which justifies contacting a doctor or an emergency service. telephone


You have completed the survey