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Has Attachments: false
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HTML Popup Type: esriServerHTMLPopupTypeAsHTMLText
symptoms_911 (type: esriFieldTypeString, alias: Does patient have severe symptoms, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
call_911 (type: esriFieldTypeString, alias: STOP AND DO NOT PROCEED TO TEST FACILITY: Please direct patient to call 911, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
info_yesverify (type: esriFieldTypeString, alias: Is person a member of vulnerable population (elderly 60+, underlying chronic conditions, etc?), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
first_responder (type: esriFieldTypeString, alias: Are you a healthcare worker or first responder?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
responder_type (type: esriFieldTypeString, alias: Which of the below best describe your response field?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
responder_other (type: esriFieldTypeString, alias: Field of Service, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
symptoms_worsen (type: esriFieldTypeString, alias: Has your temperature or symptoms worsened since completing initial online assessment?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
temperature (type: esriFieldTypeString, alias: Temperature, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [temp_1: Temperature above 100.4 °F (38 °C)], [temp_2: Older than 65 and temperature above 99.6 °F (37.5 °C)], [temp_3: I feel feverish], ... 2 more ...)
bmi_40 (type: esriFieldTypeString, alias: BMI over 40 counts as an underlying condition, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
onset_exposured (type: esriFieldTypeString, alias: (Travel to restricted areas (CDC Guidance*, local sepcific**), close contact with confirmed COVID19 case (if yes note and refer to epidemiology team), been on a cruise (cruise ships, river ships, etc), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
where_dom (type: esriFieldTypeString, alias: Where did you travel domestically?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
close_contact (type: esriFieldTypeString, alias: Have you come into close contact with a confirmed COVID-19 case?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
congregate_history (type: esriFieldTypeString, alias: Have you spent any time in a healthcare facility, nursing home, jail, childcare facility, or place of worhsip in the last 14 days?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
test_request (type: esriFieldTypeString, alias: Are you requesting a COVID-19 test?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
request_decline (type: esriFieldTypeString, alias: STOP AND DO NOT PROCEED TO TEST FACILITY: If the caller has declined ensure that they know they will need to resubmit another online assesment to be able to qualify for testing., SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
no_symptomsworse (type: esriFieldTypeString, alias: STOP AND DO NOT PROCEED TO TEST FACILITY: Reasurance proceed as usual - reinforce that patient should call before seeking additional care (if symptoms worsen) and provide additional guidance from appropriate health deparment/resources, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
drive_ability (type: esriFieldTypeString, alias: Are you able to drive or be driven to the testing site?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
no_ability (type: esriFieldTypeString, alias: Which of the below best describe your difficulty traveling to test site?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
travel_ability_note (type: esriFieldTypeString, alias: Please notify caller that a nurse will call them to schedule a home-based test
no_vehicle_note (type: esriFieldTypeString, alias: Apologies, home-based testing is limited and the current prioritization is on those who are physically unable to leave their homes. , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
family_members (type: esriFieldTypeString, alias: Are there additional people associated with you that will require additional tests?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [yes: Yes], [no: No])
family_note (type: esriFieldTypeString, alias: EVERY ADDITIONAL PATIENT MUST HAVE A UNIQUE ID # AND RECOMPLETE THE SCREENING/QUALIFICATION PROCEDURE FOR EACH ACCOMPANYING PERSON, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
all_symptoms (type: esriFieldTypeString, alias: Patient has met test criteria - Please proceed , SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
language (type: esriFieldTypeString, alias: Language (if not English), SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
contact_type (type: esriFieldTypeString, alias: What is your exposure to others who are known to have COVID‑19?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)