URI 2020 Screening Questions

Onset of symptoms: [text name="variable_1" default=""] days ago

Symptoms:
[checkbox name="variable_1" value="subjective fever|chills|nasal congestion|rhinorrhea|ear pain|sore throat|myalgias|productive cough|dry cough|headache|facial pain|nausea|vomiting|diarrhea|fatigue|dyspnea on exertion|lightheartedness"]

Therapies tired: 
[checkbox name="variable_2" value="Acetaminophen/Ibuprofen|OTC cough medication|lozenges|nothing"]  
[comment memo="Other:"][text name="variable_2" default=""]

Symptoms are [select name="variable_4" value="IMPROVING|WORSENING |STAYING THE SAME"] since onset
[comment memo="STREP SCREENING"]
Is sore throat the main complaint without concurrent cold-like symptoms (nose/eyes/etc)? [select name="Centor" value="no|YES"][comment memo="Choose 'yes' to bring up Centor Criteria"][conditional field="Centor" condition="(Centor).is('YES')"]

Denies: [checkbox name="variable_18" value="dyspnea on exertion|subjective fever|productive cough|myagl"]


Modified Centor Score
[select name="Q1Fever" value="No (0 points)=0|YES (1 point)=1"] <-- History of fever or measured temperature > 100.4 degrees F
[select name="Q2Cough" value="Cough is present (0 points)=0|COUGH IS ABSENT (1 point)=1"] <-- Presence of coughing
[select name="Q3Nodes" value="No (0 points)=0|YES (1 point)=1"] <-- Tender anterior cervical nodes
[select name="Q4Tonsil" value="No (0 points)=0|YES (1 point)=1"] <-- Tonsillar swelling or exudates
[select name="Q5Age" value="< 15 years (1 point)=1|15 to 45 years (0 points)=0|> 45 years (-1 point)=-1"] <-- Age
Score --> [calc value="score=(Q1Fever)+(Q2Cough)+(Q3Nodes)+(Q4Tonsil)+(Q5Age)" memo="score"][/conditional]

[comment memo="COVID-19 QUESTIONS"]

Documented fever: [select name="variable_1" value="NO|YES"]
Close contact with person with confirmed or suspected COVID-19: [select name="variable_2" value="NO|YES"]
Travel to high risk COVID-19 areas per current local guidance: [select name="variable_3" value="NO|YES"]
Onset of symptoms: days ago

Symptoms:


Therapies tired:

Other:

Symptoms are since onset
STREP SCREENING
Is sore throat the main complaint without concurrent cold-like symptoms (nose/eyes/etc)? Choose 'yes' to bring up Centor Criteria

COVID-19 QUESTIONS

Documented fever:
Close contact with person with confirmed or suspected COVID-19:
Travel to high risk COVID-19 areas per current local guidance:

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.87, 21 form elements, 46 boilerplate words, 2 text boxes, 3 checkboxes, 10 drop downs, 4 comments, 1 calculations, 1 conditionals, 37 total clicks
Questions/General site feedback · Help Ticket

One response to “URI 2020 Screening Questions”

  1. marnold2777 says:

    I noticed some errors in this template and not sure if you were aware, also unsure if it is still in progress, here’s my suggested fix:

    Onset of symptoms: [text size="5"] days ago
    Symptoms:
    [checkbox value="subjective fever|chills|nasal congestion|rhinorrhea|ear pain|sore throat|myalgias|productive cough|dry cough|headache|facial pain|nausea|vomiting|diarrhea|fatigue|dyspnea on exertion|lightheartedness"]

    Therapies tired:
    [checkbox value="Acetaminophen/Ibuprofen|OTC cough medication|lozenges|nothing"]
    [comment memo="Other:"][text size="60"]

    Symptoms are [select value="IMPROVING|WORSENING|STAYING THE SAME"] since onset

    [comment memo="STREP SCREENING
    "]Is sore throat the main complaint without concurrent cold-like symptoms (nose/eyes/etc)? [select name="Centor" value="no|YES"][comment memo="Choose 'yes' to bring up Centor Criteria"][conditional field="Centor" condition="(Centor).is('YES')"]

    Modified Centor Score
    [select name="Q1Fever" value="No (0 points)=0|YES (1 point)=1"] 100.4 degrees F
    [select name="Q2Cough" value="Cough is present (0 points)=0|COUGH IS ABSENT (1 point)=1"] <– Presence of coughing
    [select name="Q3Nodes" value="No (0 points)=0|YES (1 point)=1"] <– Tender anterior cervical nodes
    [select name="Q4Tonsil" value="No (0 points)=0|YES (1 point)=1"] <– Tonsillar swelling or exudates
    [select name="Q5Age" value=" 45 years (-1 point)=-1"] [calc value="score=(Q1Fever)+(Q2Cough)+(Q3Nodes)+(Q4Tonsil)+(Q5Age)" memo="score"]

    [/conditional]Denies: [checkbox value="dyspnea on exertion|subjective fever|productive cough|myalgias"]
    [comment memo="
    COVID-19 QUESTIONS"]
    Documented fever: [select name="variable_1" value="NO|YES"]
    Close contact with person with confirmed or suspected COVID-19: [select name="variable_2" value="NO|YES"]
    Travel to high risk COVID-19 areas per current local guidance: [select name="variable_3" value="NO|YES"]

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