Health beyond borders

GlobePatient

Accelerating doctor-patient communication in multiple languages

 
Yes
No
 
Yes
There is a possibility
None that I am aware of
 
 
Yes
No
 
 
 
I stay mostly at home
Working at home
Working at an office
Working with constant public contact
Student
Working inside a hospitall
Health professional
 
I rather not inform
Alone
Alone with homecare
With partner
With Family
Retirement home
Special accommodation
 
Female
Male
Transgender
 
Not applicable
Yes
There is a possibility
Not that I am aware of
No
 
Not applicable
Yes
No
 
High Fever (> 38.0 o.C)
Dry cough
Cough with mucus
Sneezing
Running nose
Shortness of breath
Chills
Nausea
Vomiting
Diarrhea
Headache
Low Fever (< 38.0 o.C)
None of the above
 
 
 
Less then 24 hours
Between 1 and 3 days
1 week
Between 1 and 2 weeks
More than 3 weeks
More than 1 month
More than 3 months
 
Yes
No
 
 
 
Asthma
Chronic Obstructive Pulmonary Disease (COPD)
Another lung disease
Hypertension (high blood pressure)
Coronary artery disease
Arrythmia of the heart
Diabetes
Cancer
Chronic kidney disease
Autoimmune disorder (lupus, scleroderma)
Cirrhosis
Other diseases liver
HIV (AIDS)
Tuberculosis
None that I am aware of
 
 
Yes
No
 
Chemotherapy
Radiotherapy
Immunotherapy
Targeted therapy
Yes, but not sure which type
Don't know
 
Yes
No, but I have done before
No
 
 
Every day
Between 2 and 4 times per week
Between 2 and 4 times per month
Seldom
Never
 
None that I am aware of
Spring season allergy
X-ray contrast
Adhesive from bandages
Latex
Medications
 
 
 
 
Yes
No
 
 

Questionnaire COVID-19 

Powered by GlobePatient

info@globepatient.com

Copyright @ All Rights Reserved