COVID Test

COVID (Oct 2020)

Application to be tested for COVID

Book Now via https://www.nassau.ie/book
Note - This a TELEPHONE CONSULTATION (not Face-To-Face)
PPSN + EIRCODE + CONSENT - do you have (a) your PPSN (b) your EIRCODE and (c) do you consent to the information you provide being shared with the HSE & DEASP?*
- YES
- NO
YOU CANNOT CONTINUE WITHOUT (a) YOUR PPSN & (b) EIRCODE and (c) GIVING CONSENT
1 of 4 - Patient Details
PPSN - Personal Public Service Number*
7 numerical characters followed by 1 alphabetical character (Note - sometimes there are 2 alphabetical characters)
RE INPUT YOUR PPSN (Do Not Copy & Paste)*
What is your 7 character EIRCODE?*
VERY IMPORTANT - You can find your EIRCODE (which is 7 characters long) using the following link https://finder.eircode.ie/#/
RE INPUT your EIRCODE (Do Not Copy & Paste)*
VERY IMPORTANT THAT THIS IS ACCURATE
Your Mobile Telephone Number*
Re INPUT Your Mobile Telephone Number (Do Not Copy & Paste)*
Patient's Family Name / Surname?*
Patient's First Name?*
Patient's Date of Birth*
DAY ****** MONTH **** YEAR
SEX*
- Female
- Male__
- Other_
Email*
Have you ever made an application to be tested (Y/N)*
- YES
- NO
When / What Date did you make application?
Date Format: MM slash DD slash YYYY
Were you offered a Test Date & Time?*
- YES
- NO
Did you attend for testing at the location and time you were offered?*
- YES
- NO
Why did you not attend?*
What was the result of your Test?*
- COVID Positive
- COVID Negative
- I await my result
2 of 4 - COVID-19 Risk Factors
Have you been in contact (in the past 14 days) with a person who was confirmed to have COVID-19?
- YES
- NO
In respect of the person that was confirmed as having COVID-19 is any of the following true:
- I was less than 2 metres from them
- I spend more than 15 minutes with them
On what date (approximately) did that person test positive?*
Date Format: MM slash DD slash YYYY
What is your relationship to the person who tested positive?*
- Partner
- Live in same house
- Work
- Friend
- Restaurant
- Social Occasion
What is your temperature NOW?
- 36-36.9°C
- 37-37.9°C
- 38.-38.9°C
- 39-39.9°C
- >=40°C
Did you measure your temperature with a thermometer?
- YES
- NO - it is a guess
Do you have a cough?
- YES
- NO
Do you have shortness of breath?
- YES
- NO
Have you lost your sense of SMELL?
- YES
- NO
Have you lost your sense of TASTE?
- YES
- NO
Are you a health care worker?
- YES
- NO
Name the facility, location and your responsibilities?*
Are you IMMUNOSUPPRESSED?
- YES
- NO
Please provide details of your decreased immunity?
TRAVEL - In the past 30 days have you been outside of the island of Ireland?*
- YES
- NO
Please click each one of the following places that you visited (or transit through):
- China
- Hong Kong
- Iran
- Japan
- South Korea
- Singapore
- Europe
- Another country not listed above
What other country / continent did you visit?
Please click each one of the following European places that you visited (or transit through):
- Italy
- France
- Germany
- Spain
- Britain
- Other European countries not listed above
What other European countries did you visit?
3 of 4 - TRANSPORT - what methods will you use to travel to the COVID Test Centre?*
- Car or Taxi
- Bicycle / Scooter
- Walk
You are not permitted to use a bus or train as there is a risk that you may infect other people.
4 of 4 - Entitlement to COVID-19 Payments of €350 per week.
If the Doctor directs you to self-isolate, you may be entitled to a COVID-19 payment of €700 (€350 per week for 2 weeks) from the Department of Employment Affairs and Social Protection (DEASP) on condition that the Doctor issues a “Medical E-Certificate of Incapacity for Work” to the DEASP.
If the Doctor directs you to self-isolate do you want us to send a “Medical E-Certificate of Incapacity for Work” to the DEASP?
- No
- Yes
For additional information on "Medical E-Certificate of Incapacity for Work" read FAQ 13 on our website https://www.nassau.ie/faq/

COVID (Oct 2020)

Book Now via https://www.nassau.ie/book

Note - This a TELEPHONE CONSULTATION (not Face-To-Face)

YOU CANNOT CONTINUE WITHOUT (a) YOUR PPSN & (b) EIRCODE and (c) GIVING CONSENT

1 of 4 - Patient Details

2 of 4 - COVID-19 Risk Factors

4 of 4 - Entitlement to COVID-19 Payments of €350 per week.