The code block below illustrates how one might use # and // as comments in your logic and calculations.

# Text can be put here to explain what the logic/calculation does and why.
if ([field1] = '1' and [field2] > 7,

	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

Working …

This value you provided is not a number. Please try again.

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The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

EVMS/EVMS Medical Group Travel Survey

Please complete the survey below.

Thank you!

The option "" can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?

First Name

* must provide value

Last Name

* must provide value

Position/Classification

* must provide value

Involved in Direct Patient Care?

* must provide value

Yes

reset

Department

Educational Program

Phone number (Best)

* must provide value

Direct Supervisor or Program/Instructor: Name

* must provide value

Direct Supervisor or Program/Instructor: Email

* must provide value

Have you completed;

2 doses of mRNA vaccine (Pfizer/Moderna) or
1 dose of Johnson&Johnson/Janssen vaccine

* must provide value

Yes

reset

Have you Received a Booster Dose at least two weeks ago?

* must provide value

Yes

reset

Have you traveled internationally in the last 2 weeks?

* must provide value

Yes

reset

Travel Table

Location(s) of Travel

Date of Arrival

M-D-Y

Date of Departure

M-D-Y

Add Another Location

Location(s) of Travel

Date of Arrival

M-D-Y

Date of Departure

M-D-Y

Add Another Location

Location(s) of Travel

Date of Arrival

M-D-Y

Date of Departure

M-D-Y

Add Another Location

Location(s) of Travel

Date of Arrival

M-D-Y

Date of Departure

M-D-Y

Add Another Location

In the past 14-days, did you travel domestically, outside of Hampton Roads (i.e. Chesapeake, Franklin, Hampton, Isle of Wight, Newport News, Norfolk, Poquoson, Portsmouth, South Hampton, and Virginia Beach)?

* must provide value

Yes

reset

Arrival Date

M-D-Y

Departure Date

M-D-Y

Have you had an exposure to a confirmed or suspected COVID 19 case during your travel:

* must provide value

Yes

reset

Have you had COVID in the last 90 days?

* must provide value

Yes

reset

Are you currently experiencing any signs or symptoms of COVID-19; including:

* must provide value

Fever (100.4 degrees or higher)

Signs/symptoms of a lower respiratory illness (cough or shortness of breath)

Loss of sense of taste or smell

Sore Throat

Runny Nose

Abdominal Pain

Chills

Vomiting

Nausea

Diarrhea

Headache

Fatigue

General Malaise

Rash

Conjunctivitis

Muscle Aches

Joint Aches

Loss of Appetite

Nose Bleed

Other

N/A - I do NOT have any symptoms


Symptoms	Exposure	Recovered	International	Domestic	UnVaccinated

ALERT for Travel

You have traveled internationally or domestically within the last 2 weeks and have symptoms that might be consistent with COVID 19 and further evaluation by Student Health for students or Occupational Health for employees is needed. Please complete and submit the EVMS/EVMS Medical Group Exposure Survey.

Please do not report to work and notify your supervisor. If you are currently at work, leave work immediately and notify your supervisor. Occupational Health or Student Health (whichever is applicable) will reach out to you on the following business day. If you do not receive a call before noon on the following business day, please contact Student Health at 446-5700 if you are a student or all others please contact Occupational Health at 446-5870. For urgent questions only AND if it outside of normal Occupational Health business hours, the exposure pager may be called at (757)669-1157.

Please note that testing for COVID 19 in the drive through is done by appointment only and conducted Monday through Friday.

Alert for not fully vaccinated
You have not completed COVID 19 vaccination and traveled internationally within the last 2 weeks.
You must have a copy of a negative test within 3 days prior to travel to USA. Additionally, you need testing on day 3-5 after arrival in the USA and need to quarantine at home until day 7.
EVMS Drive Through does not routinely perform testing for personal travel.

If the test result on day 3-5 after arrival is positive, then 10 days of isolation is required as is being afebrile for 24 hours. Please contact Student Health for students or Occupational Health for employees for further steps. Please do not report to work and notify your supervisor.

If you do not receive a call before noon on the following business day from Student Health for students or Occupational Health for employees, please contact Student Health at 446-5700 if you are a student.
All others please contact Occupational Health at 446-5870.

For urgent questions only AND if it outside of normal Occupational Health business hours, the exposure pager may be called at (757)669-1157. Please note that testing for COVID 19 in the drive through is done by appointment only and conducted Monday through Friday

You have traveled domestically within the last 2 weeks. Travel increases your chances of getting and spreading COVID-19. There are no quarantine requirements for people arriving to the Commonwealth from other U.S. locations.

Watch your health and take your temperature if you feel sick. To help keep track of your symptoms, you can choose to download the “Asymptomatic Exposed 14 day Symptom Self- Monitoring Form” on the EVMS MyPortal site at: https://myportal.evms.edu/covid-19resources/.

Should you develop any symptoms within 10 days of your return date or if you think you had an exposure to COVID 19 positive or suspected case please complete and submit the EVMS/EVMS Medical Group Exposure Survey If you have any questions please contact Human Resources at 446-6043 or for students please contact Student Health at 446-5700.

Alert for fully vaccinated
You have completed COVID 19 vaccination and traveled internationally within the last 2 weeks. You must have a copy of a negative test within 1 day prior to travel to USA.
Additionally, you need testing on day 3-5 after arrival to the USA.
EVMS Drive Through does not routinely perform testing for personal travel.

If you do not receive a call before noon on the following business day from Student Health for students or Occupational Health for employees, please contact Student Health at 446-5700 if you are a student or all others please contact Occupational Health at 446-5870.

Alert for Exposure or Symptoms

You indicated that you were exposed or have symptoms that might be consistent with COVID 19 and further evaluation by Student Health for students or Occupational Health for employees is needed.

IF YOU WERE VACCINATED WITH 2 DOSES of mRNA VACCINE (PFIZER/MODERNA) OR ONE DOSE OF JOHNSON&JOHNSON MORE THAN 2 WEEKS AGO and EXPOSED TO COVID 19 case during your travel AND HAVE NO SYMPTOMS you can return to your normal scheduled work/activities.

If you have not been “fully vaccinated” as mentioned above, please complete and submit the EVMS/EVMS Medical Group Exposure Survey. Please do not report to work and notify your supervisor. If you are currently at work, leave work immediately and notify your supervisor.

Occupational Health or Student Health (whichever is applicable) will reach out to you on the following business day. If you do not receive a call before noon on the following business day, please contact Student Health at 446-5700 if you are a student or all others please contact Occupational Health at 446-5870. For urgent questions only AND if it outside of normal Occupational Health business hours, the exposure pager may be called at (757)669-1157. Please note that testing for COVID 19 in the drive through is done by appointment only and conducted Monday-Friday.

You are fully immunized according to the CDC guidelines, Have not traveled Internationaly or Domestically and have no symptoms or exposure. Quarantine is not needed.

No testing or quarantining is required for international travelers who have recovered
from Covid-19 disease in the past 90 days.

A proof of Covid-19 positive test date is required as is a statement from a provider that person is past isolation. Please contact Student Health for students or Occupational Health for employees.

If you do not receive a call before noon on the following business day from Student Health for students or Occupational Health for employees, please contact Student Health at 446-5700 if you are a student or all others please contact Occupational Health at 446-5870.

You Have not traveled Internationaly or Domestically and have no symptoms or exposure. Quarantine is not needed. You have also indicated that you are not vaccinated or Are vaccinated but have not received a booster dose.
Vaccination can minimize the risk of infection and minimize symptoms if you do contract COVID-19.

Please consider contacting Occupational Health or Student Health (whichever is applicable) to discuss getting vaccinated. Students please contact Student Health at 446-5700 all others please contact Occupational Health at 446-5870. For urgent questions only AND if it outside of normal Occupational Health business hours, the exposure pager may be called at (757)669-1157. Please note that testing for COVID 19 in the drive through is done by appointment only and conducted Monday-Friday.

You Have not traveled Internationaly or Domestically and have no symptoms or exposure. Quarantine is not needed. You have also indicated that you are not vaccinated but have recovered from a COVID-19 infection within the past 90 days. While the natural immune response to a COVID-19 infection does provide some protection from another infections, receiveing a Vaccination can further minimize the risk of infection and minimize symptoms if you do contract COVID-19 again.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.

EVMS/EVMS Medical Group Travel Survey

Have you completed;

2 doses of mRNA vaccine (Pfizer/Moderna) or

1 dose of Johnson&Johnson/Janssen vaccine

Have you Received a Booster Dose at least two weeks ago?

You have selected an option that triggers this survey to end right now.