This form is intended to facilitate COVID-19 related documentation for a variety of scenarios or contexts. It may be used as a stand-alone form or in conjunction with standard TSWF forms. Other forms can be used to document other elements of care such as PMH, physical exam, etc


DHA Covid-19 Recent Changes

See Visual Change Log (below) for Core-Compatible form changes that apply to this form.

No specific changes this update

Mid-Cycle Changes:

COVID-19 Assessment Tab

  • Update form to match the COVID-19 Registry with these elements:
    1)’Onset of earliest symptom’ added as the first field in the COVID-19 Related ROS
    2) Known contact with a confirmed case in past 14 days – ‘Confirmed COVID-19 Contacts or exposure’ updated to say, ‘Confirmed COVID-19 Contact or exposure within the past 14 days’
    3) Domestic travel – ‘Recent Travel’ was updated to 2 different items:
    Recent International Travel. If yes, describe:
    Recent Domestic Travel. If yes, describe:
    4) Altered consciousness/confusion added to the COVID-19 Related ROS
    5) Added ‘Has the patient been self-quarantining? If yes, for how many days?’
    6) Added ‘Has the patient been practicing social distancing? If yes, when did he/she start?’
    7) Added ‘Does the patient live independently (outside of medical/assisted living/nursing facility)?’
    8) Added ‘Does the patient live in on-base housing?’
    9) Added ‘Does the patient live in the barracks? If yes, describe the living area i.e. single room, roommate, open bay, room number’

This AIM form was released on 23 April 2020 and aligns with MHS GENESIS content which is based on current CDC guidance. Given the evolving nature of the COVID-19 pandemic, frequent changes are anticipated. The form optimizes a balance of availability, simplicity, and adaptability. As in other AIM form pre-populated text fields, text can be edited to meet local or individual patient circumstances.

Form Lead

TSWF-DHA Covid-19 Form Lead

James Neville

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