Skip to main content

COVID-19 Treat and Release Follow up Questionnaire

Language/Langue

The Regional Paramedic Program for Eastern Ontario is conducting a survey of patients who have COVID symptoms and are released from care following a 911 call.  

"We would like to ask you seven questions about your experience during the last 911 call. This information is being collected by the Base Hospital Physicians to evaluate this new COVID-19 Medical Directive. Your answers will be used for quality improvement and help shape care for future patients. This survey is voluntary and will remain with the Base Hospital Physicians as part of their medical directive evaluation. Would you be willing to complete this survey?"

I have obtained consent from the patient.
Please obtain consent from the patient to continue.
Invalid Input
Invalid Input
How are you feeling today?

Invalid Input
Have you accessed the health system since the paramedics saw you?
Invalid Input
If yes, which of the following did you access:





Invalid Input
Who did you contact?


Invalid Input

The paramedics and physician consult recommended that you could stay at home.

We have a couple of questions about that experience.

How happy or unhappy were you to have the option to stay at home?



Invalid Input
Were you left with enough information to help manage your symptoms?




Invalid Input
Did you have a clear follow-up plan before the paramedics left?




Invalid Input
Did you agree with the decision that you were well enough to stay home?




Invalid Input
Invalid Input

Questionnaire completed by:

Invalid Input
Please enter your EHSN in the appropriate box if available
Please enter your EHSN in the appropriate box if available