Omh.ny.govomhwebguidanceCOVID-19 SCREENING FORM - New York State Office of Mental ... 2025

1. Click ‘Get Form’ to open the COVID-19 Screening Form in the editor.
2. Begin by entering the Patient Name and Date of Birth at the top of the form. This information is essential for identification.
3. Proceed to Section 1, where you will answer questions regarding the patient's recovery from COVID-19. Select 'Yes' or 'No' for each question and provide additional details if applicable.
4. In Section 2, indicate whether the patient has had direct contact with a confirmed or suspected COVID-19 case within the last 10 days.
5. For Section 3, check any symptoms currently experienced by the patient. If symptoms are present, provide detailed temperature recordings and any significant comorbidities.
6. Complete Section 4 by providing test dates and results as required. Ensure all relevant information about testing is accurately filled out.
7. Finally, fill in details about vaccination status in Section 5, including the name of the referring facility and physician. Don’t forget to sign and date the form before submission.

Start using our platform today to easily complete your COVID-19 Screening Form online for free!