Symptoms Assessment for the GESM Community

COVID-19 Symptoms Assessment

Personal Information

Name

Birthday

Contact Number

Are you fully vaccinated against Covid-19?

Fully vaccinated means 2 weeks after your second dose in a 2-dose series, such as Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s

YES

Have you had your RT-PCR test done?

If yes, please indicate information:

Date done

Date of resultt

Upload test result here

Select File

Are you a Close Contact Person to a Confirmed Covid-19 Case?

YES

Are you currently experiencing any of the following symptoms?

Fever or chills

YES

Cough

Colds

YES

Shortness or difficulty of breathing

YES

Tiredness

YES

Muscle or

body aches

YES

Headache

YES

Loss of taste or smell

YES

Sore throat

YES

Diarrhea

YES

TEMPERATURE READING :

List of Close Contact Persons

Close contact means:

face to face contact with or without facemask within 1 meter for more than 15 minutes e.g., talking, meeting
direct physical contact e.g., shake hands, cheek greetings
direct care for confirmed or suspect for Covid-19 without using approved PPE
persons you ate with (indoor, regardless of distance), (outdoor within or less than 1 meter distance)

1.Name

1.Nature of Exposure

1Active Contact Number

2.Name

2.Nature of Exposure

2. Active Contact Number

3.Name

3.Nature of Exposure

3.Active Contact Number

4.Name

4.Nature of Exposure

4. Active Contact Number

5.Name

5.Nature of Exposure

5.Active Contact Number

6.Name

6.Nature of Exposure

6. Active Contact Number

7.Name

7.Nature of Exposure

7.Active Contact Number

8.Name

8.Nature of Exposure

8. Active Contact Number

9.Name

9.Nature of Exposure

9.Active Contact Number

10.Name

10.Nature of Exposure

10. Active Contact Number

Thank you for completing this Covid-19 Symptoms Assessment.

Who to contact:

Email nursejmarquez@gesm.org

mhombrobueno@gesm.org

+639171249158

More Information

What to do if you are sick:

Kindly accomplish the web-based questionnaire for assessment

Minimum Health Protocol and Procedures

Please stay healthy, practice handwashing more often, sanitize your area at home and follow home quarantine protocols such as:
Staying home for 14 days
You must separate yourself from other household members.
Use a separate bedroom and bathroom if possible.
Do not share utensils, dishes, cups/glasses, bedding, towels, and other personal items to other members of your family.
Let us know if you developed symptoms or any additional Covid-19 related symptoms during your quarantine.
The Barangay/ Local Government Unit will also contact you as part of the mandatory protocol, they will also help us in managing the situation.
Most LGUs have their Resident Doctors, they'll do online consultation as necessary
Taking vitamins and eating nutritious food will help in building up good immune system and fast recovery
Keep us updated of your condition and do not hesitate to contact us
The School Tracing Team will contact you anytime soon with regard to this matter as part of the protocol
Confidentiality of the information is always being considered

Where to do testing:

https://book.redcross.org.ph/index.php/book-a-swab-test/
https://www.stlukes.com.ph/news-and-events/news-and-press-release/better-normal-with-st-lukes-medical-center
Contact Numbers: 0287897000 local 1006/1050/5104; 09985822276
Email: productinfo@stlukes.com.ph
https://online.asianhospital.com/
Contact Numbers: 0287719000
https://www.makatimed.net.ph/covid-19
Contact Numbers: 88888999 local 7335
https://www.msrhealthcare.com/
https://www.facebook.com/almolecularlab/
Contact Numbers: 09165091689/ 0286505733
https://www.singaporediagnostics.com/
Contact Numbers: 09175664137

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COVID-19 Symptoms Assessment

Personal Information

Are you fully vaccinated against Covid-19?

Fully vaccinated means 2 weeks after your second dose in a 2-dose series, such as Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson’s

Have you had your RT-PCR test done?

If yes, please indicate information:

Upload test result here

Are you a Close Contact Person to a Confirmed Covid-19 Case?

Are you currently experiencing any of the following symptoms?

TEMPERATURE READING :

List of Close Contact Persons

Thank you for completing this Covid-19 Symptoms Assessment.

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