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  1. COVID-19 Patient Survey
    Source: University of Pennsylvania
    Date Published: 4/2020
    Format: Text
    Annotation: Brief patient-reported survey to deploy in observational studies during the COVID-19 pandemic, developed by the University of Pennsylvania in collaboration with several Center for the Treatment and Study of Anxiety (CTSA) sites. Available in seven languages: English, Chinese, French, Italian, Japanese, Korean, and Polish. Programmed in REDCap (Research Electronic Data Capture), a secure online survey application, and includes data dictionary and codebook. Contains 36 questions related to personal demographics; COVID-19 diagnosis, treatment, symptoms, and risk-reduction behaviors; general health; and personal lifestyle.

    Population: Adults only
    Length: 36 questions
    Time to Complete: ~ 15 minutes
    Mode of Administration: Online (e.g., computer-assisted interview)
    Administered by: Self Administered
    Language(s): English, Chinese, French, Italian, Japanese, Korean, Polish (see Language folder for surveys)

    COVID-19 Patient Survey Full Questionnaire: https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient.pdf
    COVID Diagnosis and symptoms: Diagnosis; General Symptoms; Foreign Travel https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Diagnosis.pdf
    General health questions: Social Distancing; Chronic Health Conditions; Health History https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Health.pdf
    Personal lifestyle questions: Substance Use; Education; Employment https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Lifestyle.pdf

    Chinese:
    COVID-19 Patient Survey (Chinese): Full Questionnaire https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Chinese.pdf
    COVID Diagnosis and symptoms (Chinese): Diagnosis; General Symptoms; Foreign Travel https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Diagnosis_Chinese.pdf
    General health questions (Chinese): Social Distancing; Chronic Health Conditions; Health History https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Health_Chinese.pdf
    Personal lifestyle questions (Chinese): Substance Use; Education; Employment https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Lifestyle_Chinese.pdf

    French:
    COVID-19 Patient Survey (French): Full Questionnaire https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_French.pdf
    COVID Diagnosis and symptoms (French): Diagnosis; General Symptoms; Foreign Travel https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Diagnosis_French.pdf
    General health questions (French): Social Distancing; Chronic Health Conditions; Health History https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Health_French.pdf
    Personal lifestyle questions (French): Substance Use; Education; Employment https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Lifestyle_French.pdf

    Italian
    COVID-19 Patient Survey (Italian): Full Questionnaire https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Italian.pdf
    COVID Diagnosis and symptoms (Italian): Diagnosis; General Symptoms; Foreign Travel https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Diagnosis_Italian.pdf
    General health questions (Italian): Social Distancing; Chronic Health Conditions; Health History https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Health_Italian.pdf
    Personal lifestyle questions (Italian): Substance Use; Education; Employment https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Lifestyle_Italian.pdf

    Japanese:
    COVID-19 Patient Survey (Japanese): Full Questionnaire https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Japanese.pdf
    COVID Diagnosis and symptoms (Japanese): Diagnosis; General Symptoms; Foreign Travel https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Diagnosis_Japanese.pdf
    General health questions (Japanese): Social Distancing; Chronic Health Conditions; Health History https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Health_Japanese.pdf
    Personal lifestyle questions (Japanese): Substance Use; Education; Employment https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_Patient_Lifestyle_Japanese.pdf

    Korean:
    COVID-19 Patient Survey (Korean): Full Questionnaire https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_COVID_19__Patient_Survey_Diagnosis_Korean.pdf
    COVID Diagnosis and symptoms (Korean): Diagnosis; General Symptoms; Foreign Travel https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_COVID_19__Patient_Survey_Diagnosis_Korean.pdf
    General health questions (Korean): Social Distancing; Chronic Health Conditions; Health History https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_COVID_19__Patient_Survey_General_Korean.pdf
    Personal lifestyle questions (Korean): Substance Use; Education; Employment https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_COVID_19__Patient_Survey_Personal_Lifestyle_Korean.pdf

    Polish:
    COVID-19 Patient Survey (Polish): Full Questionnaire https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_CTSA_PatientSurvey_Polish.pdf
    COVID Diagnosis and symptoms (Polish): Diagnosis; General Symptoms; Foreign Travel https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_CTSA_Diagnosis_Polish.pdf
    General health questions (Polish): Social Distancing; Chronic Health Conditions; Health History https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_CTSA_GeneralHealth_Polish.pdf
    Personal lifestyle questions (Polish): Substance Use; Education; Employment https://www.phenxtoolkit.org/toolkit_content/PDF/UPenn_CTSA_PersonalLifestyle_Polish.pdf    ...[See more] [See less]
    URL: https://github.com/RitchieLab/COVID-19-patient-survey
    Type: Guideline/Assessment Tool
    Access Notes: Free/Publicly Available

    Contact information: Marylyn Ritchie marylyn@pennmedicine.upenn.edu
    ID: 22641. From: Disaster Lit®a database of the U.S. National Library of Medicine.
    REDCap: Yes.
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