Covid Screening and Consent to treatment

Appointment screening

In order to minimise risk of transmission of Covid-19 please consider the following questions. Please speak to me if they raise any issues for you:

In the last seven days:

  1. Have you had a high temperature? (this can mean feeling hot to touch on your chest and back – you do not need to measure your temperature)
  2. Have you had a new continuous cough? (this means coughing a lot for more than an hour or three or more coughing episodes in 24 hours – if you usually have a cough, it may be worse than usual)
  3. Have you lost sensations of taste or smell?
  4. Have you had close contact (under 2 metres) with anyone with a confirmed Covid-19 diagnosis or someone exhibiting the above 3 symptoms in the last 14 days
  5. Have you recently travelled abroad and/or been instructed by the government to quarantine?
  6. Have you been contacted by the government or NHS and told to self-isolate for any reason?
  7. Do you fall under the clinically vulnerable category or the clinically extremely vulnerable category (see below)?
  8. Do you live with someone who is in either the clinically vulnerable category or the clinically extremely vulnerable category (see below)?
  9. I have taken the necessary government mandated steps of conducting a risk assessment and instituting new social distancing, hygiene, hand-washing and PPE procedures in my practice to minimise the risk of Covid-19 transmission. In the course of the consultation I will have to have non-socially distanced contact with you to perform the treatment, hence while I will meet very high standards of infection protection control, it is impossible to completely eliminate risk. Please let me know that you understand this and are happy to proceed with the treatment.

Clinically vulnerable people

People in this category of risk include:
1 Anyone aged 70 and older (regardless of medical conditions)
2 Anyone under 70 with an underlying health condition (that is, anyone instructed to get a flu jab as an adult each year on medical grounds) – such as:

a) chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis

b) chronic heart disease, such as heart failure

c) chronic kidney disease

d) chronic liver disease, such as hepatitis

e) chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy

f) diabetes

g) a weakened immune system as the result of conditions such as HIV and AIDS, or medicines (such as steroid tablets )

h) being seriously overweight (a body mass index (BMI) of 40 or above)

i) pregnant women

Clinically extremely vulnerable people

People in this category of risk include:

1 Solid organ transplant recipients.

2 People with specific cancers:

a) people with cancer who are undergoing active chemotherapy

b) people with lung cancer who are undergoing radical radiotherapy

c) people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment

d) people having immunotherapy or other continuing antibody treatments for cancer

e) people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

f) people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs

3 People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD).

4 People with rare diseases that significantly increase the risk of infections

5 People on immunosuppression therapies sufficient to significantly increase risk of infection.

6 Women who are pregnant with significant heart disease, congenital or acquired.

7 Other people have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. GPs and hospital clinicians have been provided with guidance to support these decisions

Attending an appointment:

For social distancing reasons, unless you require assistance for specific support and care needs, please come alone for the appointment.  Please leave accessory items (bags and coats) in the car. If bringing sheets and blankets bring these in with you. Please sanitise your hands immediately upon arrival, sanitiser will be provided or you can bring your own.  Please wear an ordinary surgical mask to the clinic. You may bring your own or ask me to provide one for you.

Providing consent to treat you

At your appointment you will see a copy of this ‘screening and consent’ form below.  Please confirm your consent to treatment at each appointment.

Covid-19 consent form

Final screening

1  Have you had a fever in the last 7 days?

(feeling hot to touch on your chest and back)

2  Do you now, or have you recently had, a persistent dry cough?

(coughing a lot for more than an hour, 3 or more coughing episodes in 24 hours or worsening of a pre-existing cough)

3 Have you lost sensations of taste and smell?

4 Have you been in contact with anyone in the last 14 days who has been 4 diagnosed with Covid-19 or has coronavirus-type symptoms?

5 Have you been told to stay home, self-isolate or self-quarantine?

6 Do you or anyone that you live with fall into the ‘clinically vulnerable’ or ‘clinically extremely vulnerable’ categories as defined below?

Consent for treatment

I understand that, because my treatment may involve touch and close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including Covid-19.

I give my consent to receive treatment from Sylvia Schroer.