CDOCU
Toggle Navigation
Create Note
Upload PDF
Login
Create New Note
VISIT
EVAL
REVAL
DISCHARGE
Medical Record Number
Patient Name
Clinician Id
Clinician Name
Discipline
Date of Service
Time In
Time Out
Email a copy
Visit Reason
Reset
Submit
Visitnote
Clinician No. :
CovidClinicianNo
Clinician Name. :
CovidClinicianName
1. Have you been in contact with anyone who has been tested for Covid 19 or had a positive Covid 19 test ?
Yes
No
2. Are you currently experiencing any Covid 19 symptoms ?
Yes
No
3. Have you experienced any Covid 19 symptoms in the last 14 days ?
Yes
No
I cerify that I do not have any symtoms of fever and my temperature measured today is less than 100 deg F while rendering services to patient/client.
