Ecosoul Clinic Contact Risk Assessment

ARE YOU A CLOSE CONTACT?

ASSESS YOUR RISK BELOW

*questions are based on Klinik Kesihatan Seksyen 7 close contact screening questionaire

1) How many confirmed COVID-19 patients (CP) were you exposed to? *

> 1

Not sure

2) How far were you from the confirmed COVID-19 patient? *

1 metre or less

More than 1 metre

Not sure

3) How long were you with the confirmed COVID-19 patient? *

15 minutes or less

More than 15 minutes

Not sure

4) Did you physically touch the confirmed COVID-19 patient (e.g. hugging, shaking hands, contact sports etc)? *

Yes

Not sure

5) Was the confirmed COVID-19 patient coughing, sneezing or visibly unwell when you were there? *

Yes

Not sure

6) Did you touch common surfaces with the confirmed COVID-19 patient (e.g. sitting at the same table, using the same equipment, use the same toilet etc? *

Yes

Not sure

7) Was there any exposure to the saliva of the confirmed COVID-19 patient (e.g. sharing the same plate or eating utensils, kissing hands etc ? *

Yes

Not sure

8) Did the confirmed COVID-19 patient or yourself wear a mask during the encounter ? *

Yes

Not sure

YOUR COVID RISK ASSESSMENT SHOWS THAT YOUR RISK OF COVID CLOSE CONTACT IS

If you wish to proceed to book appointment for COVID test, please proceed to the enquiry form below. We will contact you to confirm appointment time via Whatsapp at 016-3609086.

COVID TEST ENQUIRY

1) Test requested: *

RT-PCR SWAB

- swabs will be taken from both nose and throat

- for HIGH risk individuals

- test will be sent to the lab, result will take 1 - 3 working days

Antigen SWAB

- swabs will be taken from the nose only

- for LOW risk individuals

- test is done onsite, result is immediate

2) Name: *

3) Identification card number/passport number: *

4) Date of Birth:

5) Contact number: *

6) Full Current Address: *

7) Name of close contact (if any):

8) Date of contact with the close contact (if any):

9) Do you have the following symptoms?

Fever

Chills

Rigors

Headache

Sorethroat

Nausea or vomiting

Diarrhoea

Lethargy

Runny nose or blocked nose

Cough

Shortness of breath

Difficulty in Breathing

Sudden new onset of loss of smell

Sudden new onset of loss of taste

10) Do you have history of

attended an event with confirmed COVID cases or been in one of the clusters' red zone area

travel to other countries/ states within 14 days

been with a confirmed COVID-19 patient in the past 14 days

ARE YOU A CLOSE CONTACT?

ASSESS YOUR RISK BELOW

*questions are based on Klinik Kesihatan Seksyen 7 close contact screening questionaire

YOUR COVID RISK ASSESSMENT SHOWS THAT YOUR RISK OF COVID CLOSE CONTACT IS

If you wish to proceed to book appointment for COVID test, please proceed to the enquiry form below. We will contact you to confirm appointment time via Whatsapp at 016-3609086.

COVID TEST ENQUIRY

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