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. 2004 Oct 29;22(6):483–487. doi: 10.1016/j.ajem.2004.07.015

TABLE 1.

SARS Screening Questionnaire

To the best of my knowledge, in the past 2 weeks;
Had fever. If Yes, state date and temperature. Yes/No
Had cough. If Yes, state date. Yes/No
Had contact with any SARS patient or “suspected SARS” cases. Give relationship and date. Yes/No
Had traveled overseas. State country and dates. Yes/No
Visited Tan Tock Seng Hospital or Communicable Diseases Centre. If Yes, State date and reasons. Yes/No
Been to any of the public hospitals/private hospitals/polyclinics/private clinics. Specify date and reasons. Yes/No

Note. Tan Tock Seng Hospital is the local hospital designated for the treatment of SARS patients. These questions were repeated for all accompanying persons as well.