Triage Form

Personal Details

DD slash MM slash YYYY

Symptoms

0 - none/not applicable 1 - today only 2 - one or two days duration 3 - three or more days duration

Treatment

Additional Information

If a rash is present, please do the tumbler glass test. The majority of red rashes should fade or disappear with the pressure of the glass. If it does NOT fade/disappear, phone us immediately or attend the Emergency Department. If the rash fades/disappears, please email a good quality photo to info@galwaybaymedicalcentre.ie - please acknowledge you have read this by clicking below.(Required)

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