RAJAVITHI HOSPITAL , Bangkok Thailand

Risk assessment form before hospital visit for COVID-19 infection
ภาษาไทย || 中文 || English || 日本

Please answer the questions truthfully

14 days before , Did you have any risk below ?

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

1 : You have stayed or came from China ( every province including Hongkong , Macao ), Japan , South Korea , Italy , Iran, France, Germany , United States of America , Switzerland , Norway , Denmark , Netherlands , Sweden , England
2 : your work was closely contacting with the traveler. 3 : You have closely exposed to patient who confirmly infected by Corona virus 2019 or under investigation for COVID-19 4 : You have closely exposed in the same room/home with someone who came from china ( every province including Hongkong , Macao ), Japan , South Korea , Italy , Iran , France , Germany , United States of America , Switzerland , Norway , Denmark , Netherlands , Sweden , England 5 : You are healthcare personnel who contact with the patient under invatigation for COVID-19