Appendix 2 PDF
Appendix 2 PDF
Additional IPAC Precautions for Return to Practice During the COVID-19 Pandemic
Appendix 2
Template – Office Screening
Reasons for visit Temperature
Positive COVID-19
Date Name (if accompanying patient, 37.8°C or
Screening
name patient) greater
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No