Screening questionnaire for triage of suspected coronavirus cases


Dear Patient,

In order to better assess your symptoms, we would like you to answer the following questions. As there are no specific symptoms, especially at the beginning of an infection with coronavirus, we would also like to ask you about recent contacts with confirmed COVID-19 cases and your recent travel-history, in order to evaluate better your personal risk.

We therefore ask you to complete the following questions conscientiously. We will contact you after evaluation to discuss the results and next steps.

Benötigen Sie eine Krankmeldung

Sie können im Folgenden den Beginn der Krankmeldung angeben.

Click or drag a file to this area to upload.
Einwilligung zur Datenübermittlung.