Please complete the FREE online triage for coronavirus brought to you by SmartDocMD. This will help to determine your risk of having the novel Coronavirus or COVID-19. This will help your local hospital system determine your need for further testing. The information will keep you and those around you safe and informed.
*Important: This tool does NOT provide a medical evaluation or diagnosis but instead identifies risk factors. Only a trained health care professional can diagnose you with COVID-19.
Please note: In the following questions “You” is defined as the patient under consideration. If you are taking this questionnaire for another person “you” can also be a minor under your care or any individual who is not able to answer (disabled, elderly, etc).
No Exposure Risk Factors for Coronavirus/COVID-19 Infection and No Illness Identified: You/the patient currently do NOT have any exposure risk factors or disease consistent with coronavirus/COVID-19.
You are STRONGLY recommended to do the following:
Both the Ohio Department of Health (ODH) and the CDC recommend social distancing, meticulous hand hygiene, and other measures to combat the spread of coronavirus/COVID-19. Please go to the ODH coronavirus website for further resources: coronavirus.ohio.gov.
Please select the button below to continue.
Exposure Risk Factors for Coronavirus/COVID-19 Infection Identified, but No Illness Reported: You/the patient reported exposure risk factors for coronavirus/COVID-19 due to travel and/or close contact history with sick individuals, however you do not report any symptoms consistent with coronavirus/COVID-19.
Both the Ohio Dept of Health (ODH) and the CDC recommend several measures to prevent spread of disease. Practice good hand hygiene, avoid touching your face, nose or mouth and try to avoid touching high traffic surfaces such as door knobs, tabletops and counters. This will help ensure you are not spreading disease in case symptoms develop later. Please visit the ODH coronavirus website for further resources: coronavirus.ohio.gov
No Known Exposure Risk Factors for Coronavirus/COVID-19 Infection Identified but Illness Reported: You/the patient reported no exposure risk factors for coronavirus/COVID-19, however you did report symptoms that MIGHT be consistent with coronavirus/COVID-19.
Please complete the remainder of the questionnaire to help your health system identify any concerning symptoms. The Ohio Dept of Health (ODH) and the CDC recommend several measures to prevent spread of disease. Practice good hand hygiene, avoid touching your face, nose, mouth or other high traffic areas such as door knobs, tabletops or counters. This will help ensure you are not spreading disease. Please visit the ODH coronavirus website for further resources: coronavirus.ohio.gov
Exposure Risk Factors for Coronavirus/COVID-19 Infection Identified AND Illness Reported: You/the patient reported exposure risk factors for coronavirus/COVID-19 due to travel and/or close contact history with sick individuals, AND you reported symptoms that MIGHT be consistent with coronavirus/COVID-19.
Please wait at your home or other area where you are isolated from others. If you do not hear from your health system please reach out to them before going anywhere. This will help ensure you are not spreading disease. The Ohio Dept of Health and the CDC recommend social distancing, frequent hand hygiene and other measures to combat the spread of coronavirus/COVID-19. Please go to the ODH coronavirus website for further resources: coronavirus.ohio.gov
On this page you will be asked to list your/the patient’s name, address and other demographic information.
This is EXTREMELY IMPORTANT to let your local hospital system know how to contact you.
Please provide the following required info for processing so your local hospital system has this information and can contact you if needed:
Please review your information carefully and click the button to submit. If you do not hear back within one business day from your hospital system please contact your local hospital system or health department directly.