2. • Highlighted question is used to document
the first section of the “Travel Screening”
• If the answer to this question is “NO” then
the rest of the travel history questions do
not need to be completed
• If patient has traveled to indicated places
or contact with a symptomatic traveler then
the rest of the travel history questions need
to be completed
3. • If patient has traveled to indicated
places or had contact with
systematic traveler in past 21 days
complete appropriate section
• For travel to Guinea/Sierra Leone
look for this set of signs/symptoms
4. • If patient has traveled to indicated
places or had contact with
systematic traveler in past 21 days
complete appropriate section
• For travel to Middle East/Korea
look for this set of signs/symptoms
5. Patient with Signs/Symptoms
VHF/Ebola:
Follow the
“Union EMS Viral Hemorrhagic
Fever/Ebola Policy”
MERS PPE:
Special Airborne N95 or PAPR Plus
Contact plus Eye Protection
All settings: “N95 fit tested mask,
gloves, gown, goggles or face shield”