Get Ny Covid-19 Screening Form 2022-2026

This guide provides step-by-step instructions on how to complete the NY Covid-19 Screening Form online. Ensuring accuracy and completeness while filling out this form is essential for the safe admission of patients to psychiatric services.

Follow the steps to complete the online screening form effectively.

1. Click ‘Get Form’ button to obtain the screening form and access it in your chosen document editor.
2. Begin by entering the patient's full name and date of birth in the designated fields at the top of the form.
3. Indicate whether the patient is currently recovering from a confirmed COVID-19 illness by selecting 'Yes' or 'No'. If 'Yes', complete the subsequent questions related to recovery.
4. Provide details for the patient's recovery, including duration without fever, improvement of respiratory symptoms, and the date of a negative follow-up test if applicable.
5. Answer whether the patient has had direct contact with a person confirmed or suspected to be positive for COVID-19 in the last 10 days.
6. Indicate if the patient is experiencing any symptoms associated with COVID-19, and detail any significant comorbidities as required.
7. For patients transferred from specific hospital settings, ensure to record the necessary information about COVID-19 testing, including dates, results, and test types.
8. Confirm whether the patient is up to date on COVID-19 vaccinations by selecting 'Yes' or 'No' and entering relevant details about the referring facility and healthcare provider.
9. Complete the form by signing with the referring physician's or nurse practitioner's name, along with their contact number, and provide the date and time the form was completed.
10. Finally, save any changes you've made to the form. You have the option to download, print, or share the completed form as needed.

Start filling out the NY Covid-19 Screening Form online today to ensure a smooth admission process.