№ files_lp_3_process_7_032477
Clinical pre-appointment screening form collecting patient-reported information on COVID-19 exposure, travel history, and related symptoms for infection control in an orthodontic setting.
Organization: American Association of Orthodontists Insurance Company (AAOIC)
Document Type: Health screening questionnaire
Subject: COVID-19 exposure and symptom screening
Intended Use: Pre-appointment patient screening
Target Audience: Orthodontic patients and accompanying parents or guardians
Medical Focus: Communicable diseases, including COVID-19
Screening Criteria: Travel history, positive COVID-19 test or diagnosis, fever, cough, shortness of breath, chest pain or pressure, loss of taste or smell
Requirement: Completion prior to each orthodontic appointment
Signature Requirement: Patient or parent/guardian signature and date
Purpose: Reduction of disease transmission within orthodontic practice
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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