FNW COVID & Influenza Like Illness Assessment Clinic
Continuity Note for Family Doctor / Referring Physician
Fax: 844-910-1874
Patient age:
PHN:
Patient Phone:
Referring Physician:
Fax:
Date:
Patient consented to send information to family physician
Dear Colleague,
Thank you for your referral to the FNW Assessment Clinic. Below is a summary of the visit.
Your patient contacted the COVID screening clinic on:
The patient was seen on:
Swab Priority:
Example: HCW1, HCW2, LTC, Pregnant, other
The patient did
NOT
qualify for COVID-19 testing.
Since the patient has URT symptoms, they were advised to
self-isolate for 10 days from symptom onset
, or until they feel better, which ever is later.
COVID-19 testing was done. Copy of result will be sent to you.
Advised to continue self isolation. If COVID-19 is negative, can stop self-isolation after
10 days
, or once feeling better. If COVID-19 is positive, the patient will be contacted for further information.
Assessment resulted in referral to Emergency Department.
Patient not seen.
Reason:
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Click Time Stamp
Signature required
Subject: