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Discipline

: General

Sub Discipline

: General

Document Title

: Covid-19 Daily Clinical Note

Date Of Onset

Day Of Fever Onset

Day of Illness

Date of Confirm

Travel History

No

History of Contact

No

Risk Factors

Asthma

Onset Symptoms

Cough

Presenting Symptoms

Cough

Current Complaints

Vital Signs

Avpu

Alert

CURB-65

Lungs Findings

Abdominal Examination

Investigations

Warning Signs

RR > 25

No

MEWS > 3

No

Sob/Lethargy

No

New/Persistance Temperature

No

SPO2 < 95

No

Increase CRP

No

ALC < 1.0

No

Increase Ferritin

No

CXR Worsend

No

PF Ratio < 300

No

Mental Health Assessment

*** Please asses patient's mental health status daily

Do you sleep well ?

No

Are you able to eat well ?

No

Are you able to control your emotion ?

No

Do you need any help ?

No

Clinical Staging of Syndrome

*** Stage 3 and above : please ALERT the specialist (ID/ Internal Medicine / Anaesthetist) STAT

PLAN

Management Plan

SIGNATURES

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