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COVID-19 Symptom Self-Assessment Tool

This self-assessment tool, developed with the MidSouth Pain, will help determine whether you may need further assessment or testing for COVID-19. You can complete this assessment for yourself, or on behalf of someone else.

If you have respiratory symptoms and a serious ongoing condition or are in the third trimester of pregnancy, please follow the advice of your specialist.

Most people do not need to be tested for COVID-19 because it will not change your care.

People who do not need to be tested for COVID-19 include:
– People without symptoms
– People who have mild respiratory symptoms that can be managed at home
– Returning travelers

Who should be tested for COVID-19?

People with respiratory symptoms who may require testing for COVID-19 include people who are:

– Hospitalized, or likely to be hospitalized
– Health Care Workers
– Residents of long-term care facilities
– Part of an investigation of a cluster or outbreak

Anyone who has symptoms – including a fever, cough, sneezing, or sore throat – should self-isolate for 10 days. Continue to complete this assessment to determine if you may need care.

Are you experiencing any of the following symptoms:

– Difficulty breathing (e.g. unable to finish sentences because of your breathing, Short of breath at rest, unable to lie down because of difficulty breathing);
– Chest pain;
– Having a very hard time waking up;
– Fainted or lost consciousness; OR
– Difficulty managing your daily life because of breathing difficulties.

NO

Are you experiencing any of the following:

– Mild to moderate shortness of breath
– Inability to lie down because of difficulty breathing
– Chronic health conditions that you are having difficulty managing because of difficulty breathing.

NO

Are you experiencing any of the following:

– Fever
– Cough
– Sneezing
– Sore throat

NO

In the past 14 days have you returned from travel to any other locations outside of USA?

Travel includes passing through an airport.

NO

Did you provide care or have close contact with a person with COVID-19

(probable or confirmed) while they were ill (cough, fever, sneezing, or sore throat)?

NO

Did you have close contact

with a person who travelled outside of United States in the last 14 days who has become ill (cough, fever, sneezing, or sore throat)?

COVID-19 Care Advice

Practice social distancing. Stay home except to get medical care. Avoid public areas and public transportation. Make sure to follow the official guidance of your city or state. This includes adhering to potential “stay-at-home” or “shelter-in-place” orders.

Wear a face mask if you are sick. If you are unable to wear a face mask (for example, because it causes trouble breathing), then others who live with you should not stay in the same room or they should wear a face mask.

Check your symptoms if anything changes.

Call ahead before visiting your doctor. This will help them take the necessary steps to keep other people from getting infected or exposed.

Call 911 if you think you are having a medical emergency. Notify the dispatch personnel that you may have been exposed to COVID-19. If possible, put on a face mask before emergency medical services arrive.

How to take care of yourself and others at home

In your home, separate yourself from other people and animals. Use a separate room and bathroom if you can. Have another member of your household care for your animals while you are sick. If you must care for your pet or be around animals, wash your hands before and after you interact with them and wear a face mask.

Cover your coughs and sneezes. Throw used tissues in a lined trash can. Wash your hands immediately with soap and water for at least 20 seconds or an alcohol-based hand sanitizer with at least 60% alcohol.

Clean your hands often by washing with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food. You can also use an alcohol-based hand sanitizer with at least 60% alcohol.

Avoid touching your eyes, nose, and mouth with unwashed hands.

Avoid sharing personal household items. Do not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets. Wash these items thoroughly after use.

Clean all “high-touch” surfaces daily. These include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Be sure to clean any surfaces that may have blood, stool, or bodily fluids on them. Household cleaners are good for this.

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