The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Txd24ua95Id2EYjP6sNJ9IvtxvWyom9Up2AI4SDWa5qZgEUxMygfy86JjKZRdimwZjTmgLGZYHkbcV

Eligibility Survey

Please complete the survey below to assess your eligibility for the Generation of Algorithms that Enable Early Detection of Symptomatic SARS-CoV-2/COVID-19 Infection in High Risk Employees research study.

Thank you!

Are you over the age of 18?

* must provide value

Yes

reset

Are you currently employed as a high risk employee such as a healthcare worker, emergency services worker, critical services cashier (cashier at grocery store, Walmart, Target, etc.), staff in a meat processing plant, or work in an area where outbreaks are beginning to occur?

* must provide value

Yes

reset

As a part of your work, do you regularly interface with patients, customers or coworkers who maybe COVID-19 positive or materials that have been exposed to COVID-19 positive people?

* must provide value

Yes

reset

Do you work at least 75% effort (e.g., 30 hours per
week)?

* must provide value

Yes

reset

Are you comfortable and willing to wear a device and interact with a tablet-based interface on a daily basis?

* must provide value

Yes

reset

Have you experienced symptoms consistent with COVID-19 within the past 60 days? This includes: loss of smell or taste, dry cough, sore throat, fever or feeling feverish, chills, muscle aches, diarrhea, or nausea

* must provide value

Yes

reset

Have you ever tested positive or have a pending test for SARS-Cov-2/Covid_19?

* must provide value

Yes

reset

Are you currently undergoing self-quarantine for suspected COVID-19?

* must provide value

Yes

reset

Are you willing to provide our research team access to your future medical records to assess the severity of your COVID-19 related disease if you
become infected?

* must provide value

Yes

reset

Are you currently enrolled in remote patient monitoring via the Center for Connected Care at Mayo Clinic?

* must provide value

Yes

reset

Yes

Implanted pacemaker

* must provide value

reset

Implanted defibrillator

* must provide value

reset

Use of a neuro-stimulator

* must provide value

reset

Bilateral axillary lymph node clearance

* must provide value

reset

Known allergy to adhesives

* must provide value

reset

Are you a:

Healthcare worker

Emergency services personnel

Critical Services sector cashier (cashier at a grocery store, Walmart, Target, etc.)

Staff in a meat processing plant

Other high risk job where outbreaks are beginning to occur

reset

Are you a:

Respiratory Therapist

NP/PA/Nurse/Nursing Assistant

Physician

Nursing home employee

Custodial staff

Other (please specify)

reset

Are you a:

Emergency first responder

Active duty police officer

Other (please specify)

reset

Other (Please Specify)

Do you work from home for any of your job-related responsibilities?

Yes

reset

Please mark all responsibilities you have.

Aerosol generating procedures (sputum induction, suctioning, high flow oxygen delivery, etc...) on known or suspected COVID-19 positive patients

Direct handling of specimens from known or suspected COVID-19 positive patients

Perform autopsies or other procedures on deceased individuals known to have, or expected to have, COVID-19

Close contact, in-patient medical care for patients that are known or suspected COVID-19 positive patients that are not undergoing aerosol-generating procedures

Patients that are known or suspected to be COVID-19 positive that are undergoing medical transport in an enclosed vehicle

Frequent and/or close contact with (i.e., within 6 feet of) people who may be infected with SARS-CoV-2, but who are not known or suspected COVID-19 patients.

Performing tasks that do not require contact with people known or suspected to be COVID-19 positive

Name

* must provide value

Telephone Number

* must provide value

Address (Street, City, State, Zip code)

* must provide value

Expand

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.