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 a sinus infection?
Less than 10 days
More than 10 days
More than 12 weeks (3 months)
2. Do you have any of the following symptoms?
Choose all that apply (you can select none)
Blocked or congested nose
Runny nose
Facial pain or a feeling of pressure
Headache
Change in your sense of smell
Cough
Fever (temperature >38°C)
Pain over the teeth or jaw
3. What colour is the discharge from your nose?
Enter text
4. How would you rate your facial pain or pressure on a scale of 0-10?
0 means you have no pain; 1-3 means mild pain; 4-7 moderate pain; 8-10 severe pain
List of numbers from 0-10
5. Do you think your symptoms are improving?
Yes
No - it's stayed the same
No - It's getting worse
6. Have you had Sinusitis before?
Yes
No
7. Tell us if you have tried anything to manage your symptoms?
These could be any medications or remedies but particularly nasal sprays, pain relief or antibiotics
Enter text
8. 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
If the patient answers yes to question 8 they will see question 9, if they answer no they skip to question 10👇
9. Tell us why you have a weakened immune system?
Enter text
10. Is there a possibility you might be pregnant?
Yes
No
Not applicable
11. Do you have any allergies?
Yes
No
If the patient answers yes to question 11 they will see question 12, if they answer no they skip to question 13👇
12. Please list any allergies and what reaction you get with them
Enter text
13. 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. 👉