MEMPHIS HEALTH CENTER, INC.

Checklist for Novel Coronavirus - 2019-nCoV

(Suspected or Confirmed)

In order to provide a safe environment for families and staff, entrance screening questions for patients and
providers will be updated Wednesday. Assess everyone entering the building with the following screening
questions below:

• Have you felt feverish or had a fever of 100.4 or greater in the past 72 hours? ____Yes ___No
• Do you have a cough not related to another medical condition? ____Yes ___No
• Are you having trouble breathing or shortness of breath? ____Yes ___No
• Are you having chills? ____Yes ___No
• Do you have loss of taste or smell not related to another medical condition? ____Yes ___No
• Do you have an inability to sleep? ____Yes ___No
• Are you having trouble concentrating or feeling like you are in a fog? ____Yes ___No
• Are you having vomiting or diarrhea in the past 24 hours? ____Yes ___No
• Has anyone in your household tested positive for COVID-19? ____Yes ___No
• Do you have a COVID-19 test pending? ____Yes ___No

If the patient has relevant exposure history/symptoms (e.g., coughing/sneezing, shortness of breath or
difficulty breathing) and responds YES to any of the questions, provide the patient/family a facemask, obtain
the patient’s cell phone number, and direct he/she to return to their vehicle and wait for your call with further
instructions.

If the patient has relevant exposure history/symptoms (e.g., coughing/sneezing, shortness of breath or
difficulty breathing) and responds NO to all questions, provide the patient a facemask. Contact triage
nurse to evaluate patients with shortness of breath and complaints of difficulty breathing immediately.

MEMPHIS HEALTH CENTER, INC.

Checklist for Novel Coronavirus - 2019-nCoV
(Suspected or Confirmed)

In order to provide a safe environment for families and staff, entrance screening questions for patients and
providers will be updated Wednesday. Assess everyone entering the building with the following screening
questions below:

• Have you felt feverish or had a fever of 100.4 or greater in the past 72 hours? ____Yes ___No
• Do you have a cough not related to another medical condition? ____Yes ___No
• Are you having trouble breathing or shortness of breath? ____Yes ___No
• Are you having chills? ____Yes ___No
• Do you have loss of taste or smell not related to another medical condition? ____Yes ___No
• Do you have an inability to sleep? ____Yes ___No
• Are you having trouble concentrating or feeling like you are in a fog? ____Yes ___No
• Are you having vomiting or diarrhea in the past 24 hours? ____Yes ___No
• Has anyone in your household tested positive for COVID-19? ____Yes ___No
• Do you have a COVID-19 test pending? ____Yes ___No

If the patient has relevant exposure history/symptoms (e.g., coughing/sneezing, shortness of breath or
difficulty breathing) and responds YES to any of the questions, provide the patient/family a facemask, obtain
the patient’s cell phone number, and direct he/she to return to their vehicle and wait for your call with further
instructions.

If the patient has relevant exposure history/symptoms (e.g., coughing/sneezing, shortness of breath or
difficulty breathing) and responds NO to all questions, provide the patient a facemask. Contact triage
nurse to evaluate patients with shortness of breath and complaints of difficulty breathing immediately.

7/13/2020