Corona Virus Treatment Survey

Covid-19 initial infection

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* 1. age of person with Covid19

100

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 2. Covid19 testing

positive

negative

not tested

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* 3. Symptoms - fever

none

< or = 100.4

= or >100.5

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* 4. symptom - cough

Yes

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* 5. symptom - fatigue

0 none

some but can function

100 bedridden

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 6. symptoms - GI

abdominal pain

diarrhea

nausea

vomiting

none

Other (please specify)

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* 7. symptoms - respiratory distress

none

mild

moderate

severe

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* 8. Overall illness

none

mild

moderate (home)

moderate (hospital)

severe (hospital)

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* 9. Medicine taken if any

hydroxychloroquine (plaquenil)

hydroxychloroquine + zithromax

remedesivir

lopinovir/retonavir

none

Other (please specify)

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* 10. Person filling out survey

patient

friend/relative/significant other

provider

Other (please specify)