In-Office Screening (내원환자질문사항)
Under the guideline from ADA(American Dental Association), all HiQ patients are required to fill out this pre-appointment screening form before any dental treatment. Thank you for your cooperation.
미국치과협회의 지침준수를 위해서 하이큐치과에 내원하시는 모든분들은 내원하신후에 치료전 아래의 질문사항에 답변을 해주셔야합니다. 협조해 주셔서 감사합니다.
Name (이름) *
Do you/they have fever or have you/they felt hot or feverish recently(14-21days)? (최근 2-3주동안 발열증상이 있으셨습니까?) *
Do you/they have a cough? (기침증상이 있으십니까?) *
Any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue? (복통, 두통, 및 몸살과 같은 감기유사 증상이 있으십니까?) *
Have you/they experienced recent loss of taste or smell? (최근 갑작스런 미각 또는 후각 상실을 경험하신적이 있으십니까?) *
Are you/they in contact with any confirmed COVID-19 positive patients? (코로나바이러스 확진자와 접촉하신적이 있으십니까?) *
Is you/their age over 60? (나이가 60세 이상이십니까?) *
Do you/they have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorders? (심장질환, 폐질환, 신장질환, 당뇨병, 및 자가면역질환이 있으십니까?) *
Have you/they traveled outside Texas in the past 14 days? (최근 2주동안 텍사스주밖을 여행하신적이 있으십니까?) *
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