Pre-screen

(Please fill out the following information for our records)
  • We require you to fill out the below questionnaire to assist in determining your eligibility for level 3 sleep testing during the COVID-19 pandemic to provide a safe environment for staff, physicians, contractors, patients and families. The information in this questionnaire is collected under the authority of FOIP section 33 (c) and will be used and disclosed solely for the purposes of safety during the COVID-19 pandemic. The questionnaire intends to identify new symptoms or worsening of symptoms.

  • Risk Assessment: Screening Questions
  • In the past 14 days:
  • If you answer “YES” to any of the above, you are not permitted to attend your appointment at this time and you must self-isolate. Complete the self-assessment tool https://myhealth.alberta.ca/Journey/COVID-19/Pages/COVID-Self-Assessment.aspx at ahs.ca/covid to determine your need for COVID-19 testing.
  • If you answer “NO” to all of the above, you can proceed with testing.
  • *Close contact includes providing care, living with or otherwise having close prolonged contact (within 2 meters) while the person was ill, or contact with infectious bodily fluids (e.g. from a cough or sneeze) while not wearing recommended personal protective equipment. **Probable case is a person with clinical illness who had close contact to a lab-confirmed COVID-19 case, while not wearing appropriate personal protective equipment, OR a person with clinical illness who meets the COVID-19 exposure criteria, AND in whom laboratory diagnosis of COVID-19 is inconclusive. Clinical illness of a probable case is new onset/exacerbation of following symptoms: fever (over 38 degrees Celsius), cough, shortness of breath (SOB)/difficulty breathing, sore throat or runny nose. Exposure criteria for a probable case is a person who, in the 14 days before onset of illness: had any history of travel outside of Canada; OR had close contact with a confirmed or probable case of COVID-19; OR is a close contact of a traveler with acute respiratory illness who returned from outside Canada in the previous 14 days; OR had a laboratory exposure to biological material (e.g. primary clinical specimens, virus culture isolates) known to contain COVID-19.
  • PATIENT INFORMATION