Page 193 - QAP Manual 2020

NCI™ ADULT IN-PERSON SURVEY (IPS) 2020-21

COVID-19

BI-68 Has this person ever been diagnosed or presumed diagnosed with COVID-19?

A person is considered to be diagnosed with or presumed diagnosed with COVID-19 if the person
has
a) Received a positive lab test for COVID-19 AND/OR
b) Been informed by a physician that they are likely to have COVID-19 AND/OR
c) Signs and symptoms that are consistent with COVID-19 (i.e. fever, cough, shortness of breath or
trouble breathing)

□ 2. Yes
□ 1. No →Skip to BI-73
□ 99. Don’t know

BI-69 Has this person ever required in-patient hospitalization due to COVID -19?

□ 98. Never diagnosed or presumed diagnosed with COVID-19
□ 2. Yes
□ 1. No →Skip to BI-73
□ 99. Don’t know

BI-70 If this person required in-patient hospitalization due to COVID-19, did this person require
intubation?
Intubation is the process of inserting a tube, called an endotracheal tube (ET), through the
mouth and then into the airway. This is done so that a patient can be placed on a ventilator to
assist with breathing during anesthesia, sedation, or severe illness.

□ 98. Did not require in-patient hospitalization due to COVID-19
□ 2. Yes
□ 1. No
□ 99. Don’t know
BI-71 If this person required in-patient hospitalization due to COVID-19, was this person sent to the
Intensive Care Unit (ICU)?

□ 98. Did not require in-patient hospitalization due to COVID-19
□ 2. Yes
□ 1. No
□ 99. Don’t know

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