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 sore throat?
Enter text
2. Have you felt feverish in the past 24 hours?
Yes
No
3. If you are able to check your temperature, please enter the reading below in degrees celsius.
If are not able, you can skip this question
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4. Do you have a cough?
Yes
No
5. Do you have a blocked or runny nose?
Yes
No
6. Do you have a rash or does your skin feel rough, like sandpaper?
Yes
No
I'm not sure
7. Are the glands in your neck swollen AND tender?
These are the glands under your jaw, chin, and either side of your neck. Feel if they are enlarged and tender with your fingertip.
Yes
No
I'm not sure
8. Are your tonsils red or swollen?
Yes
No
I'm not sure
9. Do your tonsils have yellow or white spots on them?
Yes
No
I'm not sure
10. Are you able to take a clear photo of your tonsils?
If you are able to, we will ask you to upload a photo on the next screen
Yes
No
I'm not sure
If the patient answers yes to question 10 they will see question 11, if they answer no or i'm not sure they skip to question 12👇
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
12. Do you have any allergies?
Yes
No
If the patient answers yes to question 12 they will see question 13, if they answer no they skip to question 14👇
13. Please list any allergies and what reaction you get with them
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14. Do you have a condition or use any medications that cause you to have 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 14 they will see question 15, if they answer no they skip to question 16👇
15. What is the cause of your weakened immune system?
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16. Is there a possibility you might be pregnant?
Yes
No
Not applicable
17. Please tell us the best times to contact you
We can’t guarantee a time and will only contact you during opening hours
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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. 👉