Visit for Potential COVID-19 Infection
Denver Health Note Template Version: April 13, 2020

{Choose one evaluation type from list:28170}

Chief Complaint: Possible COVID-19 illness

HPI:@PREFNAME@ is symptomatic with:

Two "points" each

  • Fever
  • Cough
  • Shortness of breath

One "point" each

  • Household contact of person with COVID-19
  • Rhinorrhea (runny nose)
  • Pharyngitis (sore throat)
  • Abdominal pain
  • Diarrhea
  • Dysgeusia/ageusia (change/loss of taste)
  • Dysosmia/anosmia (change/loss of smell)
  • Myalgia (muscle aches)

(A score of ≥ 2 points indicates someone who should be referred for testing [see blue help text below.] For those with chronic symptoms [e.g. chronic cough or fatigue] consider worsening of those symptoms over the last 2 weeks as meeting criteria.)
Date of first symptoms: ***

Other symptoms/additional HPI?
COVID-19 Deterioration Risk: if the patient is “Yes” to any of the criteria listed below they have a HIGH risk of complications due to a COVID infection. Reference: DH COVID Pulse Subsite

Clerical staff to schedule the testing at Montbello or Webb with “curbside outbreak testing” visit type.
Symptomatic patients who are not tested for COVID19 - Assuming there is no other clinical etiology, treat as if patient has COVID-19 & recommend

  • Stay home in isolation (away from others) for at least 7 days from the start of symptoms AND
  • Until they have had no fever for 72 hours (without antipyretic medication) AND
  • Other symptoms (such as cough, SOB) are improving).

Flu/RSV testing should only be performed in limited patient populations where it will change clinical management, such as admission decisions.

I have clinical concern that this patient has COVID-19. I recommended appropriate clinical management of symptoms and I sent the patient home for self monitoring per public health guidelines. This patient has a {HIGH/LOW:28189} deterioration risk for complication of COVID-19 during home monitoring and isolation.

I do not believe this patient has COVID-19

I have sent this patient for urgent evaluation

  • Surgical mask given to symptomatic patient to reduce risk of transmission
  • Isolation instructions were given and reviewed
  • Informed pt/guardian to sign up for MyChart to assist in further communication
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