Question | Response options |
Do you have a fever? | Yes/No |
Is your fever getting better or worse? | Better/Worse |
Describe the severity of your fever? | Line number from 0 to 10 |
Select your current temperature | Line number from 35 to 40 degrees |
Do you have a persistent dry cough? | Yes/No |
Rate the severity of your cough? | Line number from 0 to 10 |
Is your cough getting better or worse? | Better/Worse |
Do you cough mucus from your lungs? | Yes/No |
Please rate the severity of your mucus of phlegm | Line number from 0 to 10 |
Is your mucus improving or getting worse? | Better/Worse |
Do you have a sore throat? | Yes/No |
Do you have a newly acquired shortness of breath? | Yes/No |
Do you feel abnormally fatigued? | Yes/No |
Are your joints unusually painful? | Yes/No |
Is your skin unusually pale or clammy? | Yes/No |
Do you have any of these symptoms? Headache, muscle pains, runny nose, nausea, vomiting or diarrhea, fatigue, loss of sense or smell, altered sense of taste, jaw pain, chest pain, feeling unusually cold, new pain which prevents walking | Yes/No |
Infected with coronavirus 2019 before? | Yes/No |