COVID-19 Screening Survey

Our COVID-19 testing program is run by Advanced Diagnostics hospital emergency department. The evaluation and testing is performed by our emergency department physicians. Each patient’s symptoms and results will be reviewed by one of our emergency physicians during the time of testing to determine if any treatment and/or additional interventions are necessary. Please note that in order to minimize exposure to other patients and staff our goal is to perform all evaluation, testing and physician consultation. We feel that this process minimizes the potential exposure and transmission of this highly contagious virus. Your insurance will be billed for the hospital services and professional services related to this visit. Your health insurance carrier should cover the expenses associated with your COVID testing in full regardless of deductible and co-pays; consequently, you should not receive a bill for these services.

Please answer the questions below to help determine eligibility.

• 1.What is your reason for needing a COVID-19 test?
  • I currently have symptoms concerning for an active COVID infection.
  • I was exposed to someone for at least 15 minutes who tested positive.
  • I tested positive for COVID and I am currently still having symptoms.
  • I have no symptoms, but require a negative test in order to return to work/return to school/travel abroad.
    • COVID testing for these indications is generally not covered by insurance carriers. We can offer you testing at a cash price of $200.
      • I wish to proceed with testing.
      • I do not wish to proceed with testing.
  • My physician ordered a test prior to surgery/procedure.
    • Is your surgery/procedure scheduled at River Oaks Hospital or East Houston Hospital?
      • Yes
      • No
        • COVID testing for these indications is generally not covered by insurance carriers. We can offer you testing at a cash price of $200.
          • I wish to proceed with testing.
          • I do not wish to proceed with testing.
• 2.Are you experiencing any of the following symptoms?
  (Select all that apply)
  • Fever/Chills
  • Cough
  • Shortness of Breath
    • Are you experiencing SEVERE shortness of breath?
      • Yes
      • No
  • Fatigue
  • Muscle/Body Aches
  • Headache
  • New Loss of Taste or Smell
  • Sore Throat
  • Congestion or Runny Nose
  • Nausea or Vomiting
  • Diarrhea
  • Other
    • Please describe the symptoms you are experiencing.
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