Please answer the questions truthfully

PS. This self assessment tool is for encouraging people to be more aware of their self protection from health risks and reducing unnecessary hospital visits

Do you have any risk below?

1 : You have stayed or came from any place at risk ?

1.1 : (Oversea)You have stayed or came from oversea in past month
1.2 (Domestic) Did you ever been to place at risk in Thailand ?
 :
2 : You worked or stayed in State quanratine or local quanrantine?
// 3 : You have closely exposed to patient who confirmly infected by COVID-19
4 : You are healthcare personnel in the hospital , clinic or Drug store
5 : You have been to crowded area eg; market , supermarket , hospital or transportation station which in timeline of COVID-19 patient in past month
6. In your area , more than 5 peoples get cold , cough or fever in the same time in the same area with in a week ?

Please choose symptom(s) made you decide to visit the hospital.(within 14 days)
( if you have no symptom.Do notmark in any box )



COVID-19 testing decision is up to physician or nurse at the hospital only. This assessment cannot garantee the test.