Ireland Testing Format 2.0 FILL-IN VERSION WITH SPACES FOR TYPING AND IMAGES Autism COVID-19 Individual Health Action Plan
FILL-IN VERSION WITH SPACES FOR TYPING AND IMAGES Autism COVID-19 Individual Health Action Plan Universal 2.0 Format In order to fill-in you need to download the file as a pdf and read with adobe reader or in your browser on a computer or laptop. Contents: SECTION ONE: Do I have any Symptom's of COVID-19 Should I be tested for COVID-19 SECTION TWO: How I can contact my GP (Doctor) Who and How I contact people if I need help SECTION THREE: Your important information SECTION FOUR: How I communicate SECTION FIVE: Emergency Bag checklist in case I need to go to the hospital. Note. I am more than happy to make any specific Individual alteration as needed., e.g., specific visuals added or changed in graphics. please contact if needed. Contact Email: doylej30@tcd.ie Twitter: @JesscaDoyle Linkedin: linkedin.com/in/jessicakdoyle Link to Print only version if needed: https://www.yumpu.com/s/FRK0DeYNlZPBrGSy
FILL-IN VERSION WITH SPACES FOR TYPING AND IMAGES
Autism COVID-19 Individual Health Action Plan
Universal 2.0 Format
In order to fill-in you need to download the file as a pdf and read with adobe reader or in your browser on a computer or laptop.
Contents:
SECTION ONE:
Do I have any Symptom's of COVID-19
Should I be tested for COVID-19
SECTION TWO:
How I can contact my GP (Doctor)
Who and How I contact people if I need help
SECTION THREE:
Your important information
SECTION FOUR:
How I communicate
SECTION FIVE:
Emergency Bag checklist in case
I need to go to the hospital.
Note. I am more than happy to make any specific Individual alteration as needed., e.g., specific visuals added or changed in graphics. please contact if needed.
Contact
Email: doylej30@tcd.ie
Twitter: @JesscaDoyle
Linkedin: linkedin.com/in/jessicakdoyle
Link to Print only version if needed: https://www.yumpu.com/s/FRK0DeYNlZPBrGSy
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SECTION THREE:<br />
• Your important information<br />
Includes fillin<br />
sections<br />
___________<br />
Statements<br />
My Full name is<br />
My Date of<br />
birth is:<br />
My gender is:<br />
My Address is<br />
My Personal Details<br />
Notes to filling form out are<br />
Fill in your Answers<br />
marked with a *<br />
* Put down your first & last name.<br />
My Eircode is<br />
I have a<br />
diagnosis of:<br />
My blood type<br />
is<br />
* If you don’t know your Eircode you can<br />
find it at Eircode.ie with your address.<br />
*You can list previous diagnoses<br />
you have received from<br />
professionals.<br />
*Only write this down if you<br />
definitely know it, most people<br />
don’t and that’s okay.<br />
My GP’s (Doctor) Information<br />
List your GP (Doctors information below.<br />
My GP’s (doctor) name is<br />
My GP’s (doctor) phone is:<br />
My GP’s (doctor) address is:<br />
My emergency contacts information<br />
List your emergency contacts information below, this is also called “Next of kin” and is someone the<br />
doctors can contact for you if you are in an emergency.<br />
My Emergency contacts name is<br />
My Emergency contacts phone<br />
number is:<br />
My Emergency contacts address<br />
is:<br />
Medication I take<br />
List your prescribed medication and over-the-counter medication, such as vitamins and inhalers that<br />
you take.<br />
(*Some people don’t take any medication so its not unusual to leave this blank.)<br />
Name the Drug Dosage Frequency Taken<br />
Medications I am allergic too<br />
List any medication you have hand an allergic reaction to in the past.<br />
(*Lots of people are not allergic to any medication so its not unusual to leave this blank.)<br />
Name the Drug<br />
Reaction You Had<br />
<strong>Autism</strong> <strong>COVID</strong>-<strong>19</strong> <strong>Individual</strong> <strong>Health</strong> <strong>Action</strong> <strong>Plan</strong>, created<br />
by Jessica K. Doyle, <strong>Ireland</strong> 2020<br />
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