Data Collection Form_COVID-19: General Information |
In view of the current pandemic, this is an initiative of Max Healthcare to screen the general population for the COVID-19 or flu-like symptoms and track them for the same. Our objective is to screen the majority of our population for the clinical symptoms of COVID-19 and help the community by preventing the spread of this disease.
KINDLY FILL ONE FORM PER HOUSEHOLD
Your participation is highly appreciated. This is surveillance, in case you have any symptoms please contact the local or central government authorities and follow the Health Ministry guidelines.
*All data will be kept confidential and not be shared outside the concerned team. Ethics Committee's approval has been taken for this screening and it is being done in line with the Govt. of India guidelines. This is for research purpose and there is no commercial interest involved.
Initially, we will collect the baseline data through this form shared with you via WhatsApp or email and then weekly follow up for up to 8 weeks will be done through a short Follow-up form.
We would be very grateful if you could spare some of your valuable time to share your health status and contribute towards the prevention of this disease.
We would be very grateful if you could spare some of your valuable time to share your health status and contribute towards the prevention of this disease.
* Required