You should have already added additional precautions to your practice: namely sanitizing all surfaces, implementing regular hand washing and sanitizing between patients, wiping down all commonly utilized surfaces on a regular basis or between each patient encounter. You may consider removing pens and touch screens and instead manually signing your patients in. You may also consider utilizing closed or individual rooms for adjusting. If your patients reach out to you with any symptoms of COVID-19 these questions should be reviewed to assess severity and help you determine need to refer for testing or home isolation. 

State of UT health department and mask recommendations can be found at coronavirus.utah.gov.

Utah county and regional health departments are here: https://www.naccho.org/membership/lhd-directory?searchType=standard&lhd-state=UT.

Have you been exposed to someone with COVID-19? (exposure >2 hours within 6ft of someone with COVID) (been coughed on by someone with COVID)

• Do you have a fever?
• Do you have a cough? Is it productive or dry?
• Are you experiencing difficulty breathing?
• Do you fall into the high-risk category? Older Adults (>65)

People with a serious underlying medical condition like:

• Heart disease
• Diabetes
• Lung disease
• Receiving immunosuppressive medications
• Chronic kidney disease
• Emergency warning signs (immediate follow up with medical or 911):
• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

Mildly ill patients should be encouraged to stay home and in isolation, contact their healthcare provider for guidance about clinical management. Testing recommended for symptomatic individuals of older age and individuals with chronic medical conditions and/or immunocompromised state, even with mild illness.

Home Isolation Discontinue Instructions

Time-since-illness-onset and time-since-recovery strategy (non-test-based strategy) Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions: At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and, at least 7 days have passed since symptoms first appeared https://www.cdc.gov/coronavirus/2019-nCoV/index.html

• When scheduling and/or confirming patients, ask patients to stay home and contact their primary care physician if they have a respiratory illness, fever or if they have traveled outside of the country in the past 14 days and reschedule once they have the all clear from their physician.
• Adhere to CDC guidelines to prevent infections https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
• Tell staff who are sick to stay home.
• Schedule patient appointments and staff so you don’t have more than 10 people in the office at one time.
• Once patients arrive:
• Take their temperature (best practice is that the doctor or CA taking temperature should wear mask and gloves); if they have an elevated temperature, send them home with the COVID-19 hotline number: 800-456-7707
• Ask them to sanitize their hands
• Ensure they sit at least six feet apart in the waiting room, OR
• Bring patients back to a room immediately, OR
• Ask patients to wait in their car until the doctor is ready for them, then alert them via cell phone to come in
• Disinfect treatment tables after each patient (preferably in front of the patient, so the see you are disinfecting it) and high touch areas regularly. The CDC does not have specific sanitizing information for healthcare providers, but does offer these suggestions for disinfecting homes with patients who have COVID-19:
• Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning. If reusable gloves are used, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes. Consult the manufacturer’s instructions for cleaning and disinfection products used. Clean hands immediately after gloves are removed.
• If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
• For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% alcohol, and most common EPA-registered household disinfectants should be effective.
• Diluted household bleach solutions can be used if appropriate for the surface. Follow manufacturer’s instructions for application and proper ventilation. Check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against corona-viruses when properly diluted.
• Prepare a bleach solution by mixing:
• 5 tablespoons (1/3^rd cup) bleach per gallon of water or
• 4 teaspoons bleach per quart of water
• Products with EPA-approved emerging viral pathogens claims are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).