Date of filling: 21.11.2024 16:26:50 (appears automatically)
Clinic of planned treatment Kokshetau, Auelbekova Street 129/20 Uralsk, Ikhanova Street 52 Atyrau, Kulmanova Street 1 (Grand Atyrau Residential District) Ust-Kamenogorsk, Nursultan Nazarbayeva Ave. 29/23 Almaty, Kabanbai Batyra Street 122A Almaty, Rozybakiyeva Street, 105 B Almaty, Sholokhova Street 15 Nur-Sultan, Saraishyk Street 5, VP11 Nur-Sultan, Abay Ave. 28 Nur-Sultan, Kazhymukana Street 12
1. Have you been in isolation or self-isolation for the last 14 days before visiting the clinic? Yes No
2. Were there any close contacts over the past 14 days with a person under the supervision due to COVID-19, who subsequently become ill? Yes No
3. Were there any close contacts over the past 14 days with a person who was diagnosed with a laboratory confirmed COVID-19? Yes No
4. Have you visited a clinic or medical centre where patients are tested for COVID-19? Yes No
5. Have you experienced one or more symptoms in the last 14 days?
Increased body temperature over 37.5C
Cough (dry or with a small amount of sputum)
Shortness of breath
Fatigue
Feeling of stuffiness in the chest
Myalgia - muscle pain
I experienced none of the symptoms listed above
6. Have you tested for COVID-19? Yes No
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I understand that the provision of false information is a violation of the law in sanitary and epidemiological welfare of the population and it entails corresponding responsibility.
