What does this Questionnaire do?
Pharmacies can offer advice and treatment for urinary tract infections (in women), new sinus problems, sore throats, ear infections, infected insect bites, impetigo and shingles, without a GP appointment or prescription.
The questionnaire link is sent via SMS or email. The patient fills in the questionnaire through a browser so they can use their phone, tablet, laptop or desktop to complete it.
The responses are returned to the user or organisation via the Accurx Web inbox. They can also be assigned to other colleagues.
Questions:
1. How long have you had your rash?
Enter text.
2. Which part of your body is affected?
Enter text
3. Do you have any of the following symptoms?
Red sores or blisters
Yellow crusty patches
Itching
Pain
Fever (temperature >38°C)
One option can be selected.
4. Is the rash spreading to other parts of your body?
Yes
No
5. What have you tried so far to help your rash?
Enter text
6. Do you have any pre-existing skin conditions?
For example, eczema or psoriasis
Enter text
7. Do you have a condition or use any medications that cause a weakened immune system?
For example, receiving chemotherapy, long-term steroid treatment, or have an underlying condition such as leukaemia or HIV
Yes
No
8. Is there a possibility you might be pregnant?
Yes
No
Not Applicable
9. Do you have any allergies?
Yes
No
10. Are you able to take clear photo(s) of your rash?
Yes
No
Not sure
If patient answers Yes to question 10 👇
11. Upload a photo
Tips for taking a good photo:
- Make sure you have adequate lighting
- Make sure the subject is clear and in-focus (the image has crisp edges)
- Where appropriate place a ruler or coin in the photo to provide a sense of scale
Upload up to 5 photos or documents.
If a patient answers No or Not sure to question 10, question 12 replaces question 11.
12. Please tell us the best times to contact you
We can’t guarantee a time and will only contact you during opening hours
Enter text
When they have submitted their answers, they will be thanked for completing the questionnaire and given some safety netting information 👇
If you still have any questions or concerns, feel free to chat with us using the green message bubble in the bottom right-hand corner of this page. 👉