Once I am back to work, hopefully in early July, I will need to get patients to sign a Covid-19 consent form prior to treatment.  Hopefully this can be done digitally, such as by email, to save time in the treatment session. Consent and screening is important to minimise the spread of the virus.

In addition to the assessment of this screening questionnaire therapists will also have to exercise judgement over whether it is safe and justifiable to treat clinically vulnerable people and clinically extremely vulnerable people.  I will publish the British Acupuncture Guidelines on this in a separate post.

I will also detail in a separate post details of our new working practices to ensure your safety whilst Covid-19 continues to be a problem.

Name:


Date:________________________________

Covid-19 screening information

  1. Have you had a fever in the last 7 days? (Feeling hot to touch on your chest and back)      Yes/No
  2. Do you now, or have you recently had, a persistent dry cough? (coughing a lot for more than an hour, 3 or more coughing episodes in 24 hours or worsening of a pre-existing cough)                        Yes/No
  3. Have you lost sensations of taste and smell?
  4. Have you been in contact with anyone in the last 14 days who has been diagnosed with Covid-19 or has coronavirus-type symptoms?                                                                         Yes/No
  5. Have you been told to stay home, self-isolate or self-quarantine?       Yes/No
  6. Do You or anyone that you live with fall into the ‘clinically vulnerable’ or ‘clinically extremely vulnerable‘ categories ? Yes/No

 

Covid-19:  Consent for treatment

I have taken the necessary government mandated steps of conducting a risk assessment and instituting new social distancing, hygiene, hand-washing and PPE procedures in my practice to minimise the risk of Covid-19 transmission.  In the course of the consultation I will have to have non-socially distanced contact with you to perform the treatment, hence while I will meet very high standards of infection protection control, it is impossible to completely eliminate risk.  Please let me know that you understand this and are happy to proceed with the treatment.

I am the Patient or Parent/Guardian/Carer Practitioner
Name
Signed
Date
  • If you are signing on behalf of the patient, or if the patient is a minor, please state your relationship with the patient below:

I am the patient’s:________________________________________________

 

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