COTABATO REGIONAL AND MEDICAL CENTER

HOSPITAL INFECTION PREVENTION AND CONTROL UNIT

Telefax No. (964) 421-2192; Tel. No. (064) 421-2022 loc. 423
Sinsuat Avenue, Cotabato City

EREID RISK ASSESSMENT FORM

Name: ________________________________________ Date: ________________________
Age/Sex: _______ Ward/Room/Bed: ________________ Health Record No: ______________

STEP I
Symptom/s – Based Screening Form

In the past two weeks did the patient have any of the following: YES NO
1. Radiologic findings or diagnosis of Pneumonia on Chest-X-ray
2. Respiratory symptoms
a) Cough
b) Shortness of breath
c) Colds
d) Throat pain
e) Partial or total loss of smell
f) Other respiratory symptoms
g) Influenza-like symptoms (Headache, Muscle and joint pains,
Diarrhea, loss of appetite)
3. Fever more than 38ºC
4. Desaturation
5. General weakness or fatigue
6. Coryza
7. History of COVID-19 infection
8. Household member diagnosed with COVID-19 for the past 7 days

STEP II – Infectious Disease Specialist use only

Subgroup ___________ (refer to the back page)
Health Worker: Yes No
Recommended for Laboratory test? ________________________________
No PCR IDS/Resident (Name and Signature)

STEP III – Surveillance officer use only (For PCR Testing Only)
CIF/CSF taken by: ___________________________________ Date/Time: ___________________
Swab Collected/Submitted by: __________________________ Date/Time: ___________________
 COTABATO REGIONAL AND MEDICAL CENTER
HOSPITAL INFECTION PREVENTION AND CONTROL UNIT
Telefax No. (964) 421-2192; Tel. No. (064) 421-2022 loc. 423
Sinsuat Avenue, Cotabato City

A. A1 - refers to frontline workers in health facilities both national and local, private and public,
health professionals and non-professionals like students in health and allied professions
courses with clinical responsibilities, nursing aides, janitors, barangay health workers, among
others. This includes health care workers and non-health care workers involved in COVID-19
response as defined in Republic Act (RA) No. 11712.
B. A2 - refers to senior citizens/ persons aged 60 and above priories for SARS-CoV-2 resting.
C. A3 - refers to person with co-morbidities including those at high risk for severe disease
prioritized for SARS-CoV-2 testing.
D. Health care and non-health care workers - refer to all public and private medical, allied
medical, administrative, technical, support and other necessary personnel employed by, and
assigned in hospitals, health facilities, laboratories, medical or temporary treatment and
monitoring facilities, or vaccination sites. For COVID-19 pandemic, it also includes those
who are involved in COVID-19 response to mitigate transmission and prevent further loss of
lives in line with the National Action Plan against COVID-19 strategy of prevention,
detection, isolation, treatment, rehabilitation, and vaccination (PDITR+ Strategy).

Updated Interim Guidelines on Expanded Testing for COVID-19

The subgroup of at-risk individuals A-J based on DOH DM 2020- 258 and 258-A shall no
longer prevail, hence, the table below shall be the updated priority groups for testing:

Table 1.
Priority Groups Purpose of SARS COV-2 Test
A1- Health Care Workers For surveillance, to plan health system capacity
A2 – Senior Citizens
A3 – Comorbidities and high risk for Confirming COVID-19 for use of investigational
severe disease drugs
All except A1, A2, A3 with Confirming COVID-19 after onset of symptoms
symptoms of COVID-19 (optional to test)

Table 1: Priority groups for SARS-CoV-2 testing

It is emphasized that SARS-CoV-2 testing is NOT recommended for asymptomatic close
contacts. Instead, symptom monitoring is recommended. Should testing be used, it should
be done at least five (5) days from the last day of exposure. Further, SARS-CoV-2 testing is
also NOT recommended for screening asymptomatic individuals.

References:

1. Department of Health Department Circular No. 2023-0324 dated July 23, 2023 Table
2. Updated Masking, quarantine and isolation protocols
2. Unified COVID-19 Algorithms: Philippine COVID-19 Living Clinical Practice
Guidelines Version 5, October 10, 2023.
 COTABATO REGIONAL AND MEDICAL CENTER
HOSPITAL INFECTION PREVENTION AND CONTROL UNIT
Telefax No. (964) 421-2192; Tel. No. (064) 421-2022 loc. 423
Sinsuat Avenue, Cotabato City

3. PhilHealth. (2022). Retrieved from https://www.philhealth.gov.ph/circulars/2022/circ2022-

0018.pdf