TELEMEDICINE AGUA COVID-19 PRE SCREENING QUESTIONNAIRE

AGUA CALIENTE

Welcome to the AGUA CALIENTE Employees COVID-19 Testing Process.

  1. Complete the form below. VERY IMPORTANT: Every Field must be completed. ( You will not be able to submit the form unless it is complete )
  2. When completed, Click the Click to SUBMIT Button
  3. Once you submit the form, click on the Calendar Button to schedule the evaluation. Please keep in mind that many people are trying to get tested. When the Calendar opens, only available times will display. Choose a time that is closest to what you desire. (from time-to-time we may be required to reschedule your appointment, if we do we will notify you by email)
  4. ON THE DAY OF YOUR APPOINTMENT:
  5. To enter the telemedicine waiting room Click the "CLICK HERE TO START YOUR TELEMEDICINE APPOINTMENT " button on the home page.
  6. Please enter the room 5 minutes PRIOR to your scheduled appointment. Please do not be late!
  7. You will be placed in the waiting room until the Provider enters the evaluation room.
  8. During this initial call, your questionnaire will be reviewed with you. The Provider will ask detailed questions based on you answers.
  9. The information gathered from the questions asked will help the Provider to make a determination for the risk of a corona virus infection.
  10. If the Provider determines that further testing is needed, the patient will be scheduled for a drive-thru COVID-19 Collection Visit at the Premier OMC office in Indio.
  11. This will only be scheduled if a determination of a significant risk of a possible corona virus infection is made .
  12.  If the provider determines that there is no further testing required, the patient will be given instructions for either treatment, continued quarantine or return to work. 
  13. If you would like more information about this virus, we recommend going to this link: https://www.health.harvard.edu/diseases-and-conditions/coronavirus-resource-center
DOWNLOAD TELEHEALTH PATIENT AGREEMENT

Agreement Form

Total Care Work Injury Clinic - AGUA CALIENTE Employees' COVID-19 Pre-Screening Questionnaire For Telemedicine Evaluation

NOTE: EVERY FIELD ON THIS FORM MUST BE COMPLETED OR FORM CANNOT BE SUBMITTED!

Covid-19 Evaluation Form

Personal Info

Pharmacy Info

At Total Care Work Injury Clinic we have tried to make this difficult time as easy as possible for you to get tested within the recommended CDC guidelines. Once you complete the form, you must make an appointment on our special Telemedicine AGUA CALIENTE COVID-19 Evaluation & Testing Calendar. Please click on the button below and request your virtual appointment... Thank You!

COVID 19 EVALUATION& TESTING CALENDAR
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