COVID Test

COVID (Oct 2020)

Application to be tested for COVID

Book Now via https://www.nassau.ie/book
Have you ever previously made an application to be tested (Y/N)*
- YES
- NO
The HSE already have your details on file. Please contact the HSE by telephoning 1850 24 1850
As soon as the HSE answer your call choose from one of the following 6 options – *** 1. if you have received a text message with a positive test result. *** 2. if you have received a text message from the HSE to inform you that you are a close contact of someone that has tested positive. *** 3. if you are awaiting your test or have been offered a test appointment and are/ were unable to attend. *** 4. to enquire about test results. *** 5. if you received a close contact alert via the COVID Tracker App. *** 6. for general information and advice on Covid-19.
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
Have you previously made an application to be tested?*
- YES
- NO
On what date did you submit your application to be tested?*
Date Format: MM slash DD slash YYYY
Were you offered a test date and time?*
- YES
- NO
Did you attend for testing?*
- YES
- NO
What was the result?*
- Negative
- Positive
- Awaiting my result
Why did you not attend?*
PPSN - Personal Public Service Number*
7 numerical characters followed by 1 or 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*
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: DD dash MM dash YYYY
What is your relationship to the person who tested positive?*
- Partner
- Live in same house
- Work
- School or College
- 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

The HSE already have your details on file. Please contact the HSE by telephoning 1850 24 1850

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.