SARC COVID-19 screening tool
| Date: | Time of call: |
| SARC staff name: | Designation: |
| Complainant name: | Date of birth: |
| Age: | |
| Police or self-referral: | |
| Police reference: | SARC number: |
| Caller’s name: | Caller’s designation: |
| Contact telephone number and email (more than one if possible): |
Please advise complainant / referrer that a forensic medical examination cannot be organised until the following information is provided:
| Complainant | Any person planning to accompany complainant | |
| 1. Have they had contact with a known or suspected COVID-19 positive person in the last 14 days? | ||
| 2. Do they have influenza like illness?
Fever ≥37.8°C and at least one of the following respiratory symptoms, which must be of acute onset: persistent cough (with or without sputum), hoarseness, nasal discharge or congestion, shortness of breath, sore throat, wheezing, sneezing). |
||
| 3. Do they feel unwell? If so, how? | ||
| 4. When did they first have these symptoms? | ||
| 5. Have they contacted 111? When? | ||
| 6. If so, what was 111 advice? | ||
| 7. The above details have been provided by whom? |
| Client name: | SARC number: |
These details need to be discussed with a Forensic Clinician
| Name of Forensic Clinician making decision: |
Discussion details:
Assign complainant to the following categories:
| A. Asymptomatic and no apparent risk of COVID-19 | |
| B. Known COVID-19 or with symptoms suggestive of COVID-19 |
Decision after triage by Forensic Physician
| Option | Decision | Arrangements made are: |
| Examination at SARC | ||
| Arrange for telephone consultation (police referral) | ||
| Arrange for telephone consultation (self-referral) | ||
| Client has COVID-19 or has symptoms suggestive of COVID-19 but requires face to face FME | ||
| Other |
| Forensic Clinician name: | GMC /NMC number: |
| Forensic Clinician signature: | |
| Date and time: | |