Coronavirus disease (COVID-19) technical guidance by WHO Household transmission investigation protocol | Page 35

Heart disease □ Yes □ No □ Unknown
Asthma (requiring medication) □ Yes □ No □ Unknown
Chronic lung disease (non-asthma) □ Yes □ No □ Unknown
Chronic liver disease □ Yes □ No □ Unknown
Chronic haematological disorder □ Yes □ No □ Unknown
Chronic kidney disease □ Yes □ No □ Unknown
Chronic neurological impairment/disease □ Yes □ No □ Unknown
Organ or bone marrow recipient □ Yes □ No □ Unknown
Other pre-existing condition(s) □ Yes □ No □ Unknown
If Yes, specify:
9. Report of laboratory results
Please impute laboratory results once they become available in the “Laboratory results report”
10. Status of form completion
Form completed
□ Yes □ No or par ally
If No or partially, reason:
□ Missed
□ Not a empted
□ Not performed
□ Refusal
□ Other, specify:
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