Pre-Appointment Screening (내원전 환자 질문사항)
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. You will be asked to fill out the same form when you arrive at our office for your appointment. Thank you for your cooperation.
미국치과협회의 지침준수를 위해서 하이큐치과에 내원하시는 모든분들은 내원하시기 전에 아래의 질문사항에 답변을 해주셔야합니다. 내원하시는 날, 다시한번 같은 질문사항의 답변을 부탁드릴겁니다. 협조해 주셔서 감사합니다.
Your Name (성함)
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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