COVID-19: Staging environment

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Readiness assessment for delivering in-person care

The following section has been reviewed and endorsed by the Provincial Primary Care Advisory Table established by the Ministry of Health. For more information, including organizations and members involved, see the Acknowledgement and legal section.

Last reviewed: June 19, 2020
Last updated: June 19, 2020
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The full spectrum of primary care services can be provided if safety protocols are implemented and capacity exists within the practice and local healthcare community. The CEP has developed this section to support primary care providers and their staff as they gradually increase the provision of in-person services during the COVID-19 pandemic. Adapted from the Ministry of Health’s COVID-19 Operational Requirements: Health Sector Restart (June 15, 2020), this section applies to all primary care settings.

While remote services should form the cornerstone of practice during the pandemic, clinics offering in-person visits should complete a risk assessment as per the Ministry of Health’s Directive #2.  This section provides clear guidance on how to perform and implement a risk assessment in primary care. It represents the first step of an iterative process that will evolve in response to feedback and as COVID-19 evidence and best practices evolve. Feedback is encouraged and can be submitted here.

Step 1: Lay out a plan for mitigating COVID-19 transmission for in-person visits

COVID-19 hazards are:
  • Person-to-person transmission (patients, staff, and visitors)
  • Surface transmission
Identify

Under what circumstances can transmission happen?

  • Consider all aspects of the work conducted in a clinical setting – people, places, equipment, and supplies. Include non-routine activities such as deliveries, maintenance and repairs.
Anticipate

What are factors contributing to high-risk scenarios?

Consider:

  • Patients at particular risk for worse outcomes (patients with comorbidities, older adults).
  • Patients at risk for transmitting disease (children, essential workers).
  • Foreseeable risks (cleaning products running out, patient tests positive after visiting office).
  • Training, skill, and experience of healthcare workers.
Prioritize

How likely are the possible consequences to occur?

Consider:

  • Probability: the likelihood of the hazard or risk occurring.
  • Frequency: how many people will be exposed and how often.
  • Severity: the potential for the hazard to cause serious harm.
Assess controls

Is the risk controlled effectively, or is further action required?

  • If further action is required, see Step 2 to assess mitigation strategies.

Step 2: Assess possible mitigation strategies to determine feasibility for your practice setting

Clinics should assess strategies methodologically to determine what measures are feasible for each unique setting. Remember that where feasible, strategies should be adopted based on effectiveness and not ease of implementation.

Control strategies

Listed in order of effectiveness for risk reduction from most effective to least effective

Elimination

Can you physically remove the hazard?

Examples: reducing person-to-person transmission

  • Restrict patients from coming in person to the clinic. (See Step 3, balancing remote and in-person care)
  • Have staff self-monitor and not come to work if they develop symptoms. Consider using the provincial COVID-19 Self-Assessment.
  • Ensure there is space to isolate healthcare staff who develop symptoms.
  • Restrict extra visitors such as multiple family members, non-urgent services or deliveries, forms and paperwork pick up.

Is this strategy feasible?

  • No: Continue to next control type.
  • Yes: Implement. Add to the new clinic protocols, train staff, and inform patients.
Substitution

Can you replace the hazard?

Examples: reducing person-to-person transmission

  • Offer remote (virtual/telephone) visits. (See Step 3, balancing remote and in-person care).
  • Have people wait outside instead of in the waiting room, and text/call when ready.

Is this strategy feasible?

  • No: Continue to next control type.
  • Yes: Implement. Add to the new clinic protocols, train staff, and inform patients.
Engineering controls

Can you isolate people from the hazard?

Examples: reducing person-to-person transmission

  • Set certain days/times to see patients with acute respiratory/infectious illness. Send these patients directly to the exam room.
  • See populations at higher risk of COVID-19 complications at separate times (i.e. first thing in the morning).
  • Incorporate physical (plexiglass) barriers and spacing in the waiting area.
  • Screen all visitors for COVID-19 before entry into clinic and use signage to instruct patients about protocols.
  • Set specific times (when no patients are present) for non-clinical visitors (maintenance, repair, cleaning) to come to clinic.

Is this strategy feasible?

  • No: Continue to next control type.
  • Yes: Implement. Add to the new clinic protocols, train staff, and inform patients.
Administrative controls

Can you change the way people work/move through the clinic?

Examples: reducing person-to-person transmission

  • Set certain days/times to see patients with acute respiratory/infectious illness. Send these patients directly to the exam room.
  • Have only certain staff see patients with acute respiratory/infectious illness, maintaining physical distancing where possible.
  • Perform POC Risk Assessment before each patient encounter.
  • Have all patients/visitors practice hand hygiene and wear masks for source control.
  • Space chairs to ensure physical distancing and mark out spaces for lineups on the floor.
  • If staff have recently traveled or been exposed to COVID-19, contact your local health unit for directive.

Is this strategy feasible?

  • No: Continue to next control type.
  • Yes: Implement. Add to the new clinic protocols, train staff, and inform patients.
PPE

Can you protect people with protective equipment?

Examples: reducing person-to-person transmission

Is this strategy feasible?

  • No: Refer patient to a setting equipped with required PPE.
  • Yes: Implement. Add to the new clinic protocols, train staff, and inform patients.

Step 3: Find a balance between remote and in-person care

Efforts should be undertaken to reduce in-person visits, particularly when local disease burden is high. This does not require an “either/or” approach, but a thoughtful analysis of what aspects of patient care can be performed remotely in order reduce patient time in-clinic. It is recommended that remote visits be conducted first, followed by a curtailed in-person visit only as necessary. For detailed information on condition-specific information, see CEP’s COVID-19 Resource Centre.

Consider:

Patient access
  • Does the patient have access to the technology necessary to participate in remote visits? Telephone, internet/computer access?
  • Do they have the financial resources to use technology for a remote visit? (Some patients don’t have/can’t afford a data plan that would support a consultation.)
  • Does the patient have sufficient technological literacy to participate in remote visits? Download attachments, follow links, watch videos, send photos/videos?
  • Does the patient have access to a quiet and private place, where confidentiality can be maintained?
  • Are there language or other communication barriers that would make remote care difficult?
Clinical concerns
  • Is a physical exam necessary for diagnosis, treatment, or management?
  • See Determining when to schedule in-person vs remote visits for a guide on the problems that can be safely addressed and treated remotely.
  • Can a provider do a brief check in to monitor any deterioration in symptoms and can patients easily update providers on any changes?
  • Are there necessary measurements, scans, samples that can only be taken in-clinic? How often do these need to be taken?
  • Do remote consultation tools allow for appropriate level of assessment? Do photos/videos allow for high enough resolution? What are the targets for home measurements?
  • What is a reasonable amount of time for the patient to spend on the waitlist without negatively affecting health outcomes?
  • Are self-management tools and supports available to help the patient manage their condition at home? Apps, worksheets, videos, patient educators, helplines?
Community capacity
  • Would it be feasible to form a local network to “share” patients, as a way of expanding beyond the capacity of your individual setting?
  • Are community services available for coordinated care? (Assessment centres, community laboratories, pharmacies, specialists, rehabilitation)
  • How will community partners be impacted by an increase in services?
  • Are provincial services available to support care (ie. If patient is requesting a pap test, are these currently being processed provincially?)
Patient communications
  • Ensure patients know the clinic is open for services, as well as how to contact the clinic. Use physical signage, as well as outgoing voicemail and email signatures, and clinic website. Use physical signage for screening, hand hygiene, proper mask use, and respiratory etiquette. Signage should be accessible to all patients and visitors, reflecting the cultural context of the region and patient community. CMA has signage on high-level protections and symptoms available in English, French, Arabic, Cantonese, Mandarin, Punjabi, and Spanish.
  • Communications should be clear and timely for patients to ensure support across the full continuum of care. Set expectations about what to expect for in-person and remote (virtual and telephone) visits, how to provide information (consent documents, self-monitoring logs), how information will be shared (prescriptions, referrals, self-management resources), and the process for scheduling follow-ups.
  • Accept feedback and proactively request input. Identify patients/caregiver suggestions, expectations, and areas of concern.

Operational requirements for in-person care

The following section has been reviewed and endorsed by the Provincial Primary Care Advisory Table established by the Ministry of Health. For more information, including organizations and members involved, see the Acknowledgement and legal section.

Last reviewed: June 19, 2020
Last updated: October 6, 2020
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Screening and testing

Active screening
  • Patients and visitors should be screened over the phone before coming to the clinic.
  • Where patients present in-person without phone screening, patients and visitors should be screened upon arrival at the clinic.
  • If they screen positive, appointment should be deferred if possible and the individual referred for testing. If the appointment is urgent, refer the patient to the emergency room.
  • If a patient screens negative, appointment can be made. Remind the patient that if they develop symptoms between the time of the phone screening and the appointment, they should call the clinic for further instructions instead of coming in person.
  • Patients and visitors should be screened on-site before entering the clinic.
  • Patients and visitors should wear their own face covering. If they do not have one, provide one prior to entrance.
  • In-person screening must include staff protection as follows:
    • Best option: staff should be behind a plexiglass barrier.
    • Second option: If a barrier is not available, a 2-metre distance should be kept between screening staff and individuals being screened.
    • Last resort: if a barrier is not available and 2-metre distance is not possible, screening staff should wear PPE according to Droplet and Contact precautions.
  • If an individual screens positive, appointment should be deferred if it will not compromise patient safety, and the individual referred for testing.
  • Visitors who screen positive should not be permitted to accompany or visit the patient, pending test results. If the patient cannot attend the visit without the visitor, reschedule the visit for when an alternative visitor can accompany the patient.
Passive screening
  • Information about screening should be included on outgoing voicemail and email signatures, appointment confirmations, and clinic website, with links to the provincial online self-assessment tool where applicable.
  • Signage must be posted at the entrance to the clinic and in the reception area, requiring all patients and visitors to wear face coverings (if available and tolerated), perform hand hygiene, and report to reception to self-identify.
  • Signage should be accessible to all patients and visitors, reflecting the cultural context of the region and patient community. Download signage on MOH site, or see CMA’s resources in English, French, Arabic, Cantonese, Mandarin, Punjabi, and Spanish.
Care for positive-screened patients
  • Before every patient interaction, healthcare workers must conduct a point-of-care risk assessment to determine the level of precautions required.
  • Healthcare providers may provide care to patients who screen positive for COVID-19 only if they have the PPE required to follow Droplet and Contact precautions ((Surgical/procedural mask, isolation gown, gloves, eye protection -goggles or face shield)and the sufficient knowledge to follow proper donning and doffing procedures. Practice donning and doffing with a buddy if staff are still being trained on procedures.
  • If your setting does not meet these requirements, divert the care of the patient:
    • to the emergency department if the medical reason for the appointment is urgent
    • to assessment centre for assessment and testing if the medical reason for the appointment is not urgent. In the instance where the assessment centre is only able to provide a swab, and not manage the clinical presentation, a follow up appt should be booked when swab result is negative to finish assessment and management
  • Patients who screen positive should be given a surgical mask and perform hand hygiene.
  • The patient should be isolated.
  • If an exam room is available, place the patient in the room with the door closed, avoiding contact with other patients if possible.
  • If an exam room is not available, instruct the patient to wait outside the clinic and call/text them when a room is available.
  • In the exam room, the patient should have access to tissues, hand sanitizer, and a touch-free/foot pedal-operated wastebasket.
  • Instruct patient to take their mask home with them (do not leave in waiting room) and provide information on doffing procedures.
Care for negative-screened patients
  • Mask required and eye protection recommended for interactions with and within 2 meters of patients who screen negative.
  • No gown or gloves unless consistent with Routine Practices for specific patient symptoms.
  • Request all patients and visitors keep masks on.
Testing
  • All patients with at least one symptom should be tested.
    • Asymptomatic patients who are concerned they have been exposed to COVID-19 should be tested.
    • Asymptomatic patients who are at risk of exposure through their work (essential workers) should be tested.
  • If your setting is equipped, testing can happen on-site. All testing requires full droplet and contact PPE, even if the patient is asymptomatic.
  • If not equipped to offer testing, cases should be referred elsewhere (an assessment centre, Telehealth, etc.)

Risk assessment and mitigation

Operational assessment
Employer responsibilities
  • Have written measures for staff safety, including infection monitoring and control.
  • Ensure stable supply of essential supplies (drugs, PPE, hand hygiene and cleaning supplies).
  • Source and provide PPE through the regular supply chain, including regional leads or the provincial PPE Supplier Directory.
  • Ensure adequate staffing for services. Use information from Readiness assessment for primary care settings to ensure staffing needs are aligned with PPE availability.  Consider preserving staff capacity where possible in preparation for future outbreaks.
  • Ensure service offerings align with related services such as laboratory diagnostics, rehabilitation, etc.
  • Work collaboratively with local region and other primary care providers where possible to ensure coordinated service offerings.
Physical areas
  • Ensure there is sufficient space to maintain 2-metre social distancing between people.
  • Redesign physical settings and interactions to minimize contact.
  • Provide face coverings where physical distancing is not possible.
  • Request all patients and visitors wear face coverings if they have them.
  • Provide tissues and lined garbage bins for patients and staff.
  • Ensure sufficient supplies for proper hand hygiene: hand washing stations and 70% alcohol hand sanitizer.
  • Post signage about symptom screening, hand hygiene, proper mask use, and respiratory etiquette. CMA has signage on high-level protections and symptoms available in English, French, Arabic, Cantonese, Mandarin, Punjabi, and Spanish.
Daily operations
  • Employers and healthcare workers should determine which visitors are essential, and restrict all other visitors from entering the clinic.
  • Where possible, schedule symptomatic patients for end-of-day visits.
  • Minimize the time patients spend in the waiting room. If possible for patient, have them wait outside or in the car – otherwise, stagger appointments so that social distancing can be maintained.
  • Minimize staff in the healthcare setting. Consider which roles can be performed remotely, or develop shifts to meet the necessary number of on-site staff while ensuring social distancing.
  • Ensure healthcare workers, staff, and patients use proper PPE across clinic settings and have adequate observed training in donning and doffing.
  • Healthcare providers should preserve the use of PPE by applying other mitigation strategies identified through the Readiness assessment for primary care settings.
  • If a patient comes into the setting and later tests positive, contact local health unit for advice and guidance about the risk of possible exposure for healthcare workers.
Healthcare worker infection control
  • Staff should self-monitor for symptoms and not come to work if they develop symptoms. Consider using a daily screening form, log or app for staff as a prompt for this.
  • Ensure there is space to isolate healthcare staff who develop symptoms.
  • If a healthcare worker develops symptoms at work, they should put on a mask if not already wearing one, isolate, and they should be sent home as soon as possible.
  • If they are critical to operations, healthcare workers who have returned from travel within the last 14 days (outside of Canada or from a COVID infected area within Canada) or had a confirmed exposure to a COVID-19-positive patient must self-monitor for symptoms but may continue to work with specific precautions.
Cleaning
  • After every patient visit (symptomatic or asymptomatic), sanitize treatment areas, horizontal surfaces and equipment before another patient is brought in. Remember to include administrative equipment – mouse, keyboard, printer, etc.
  • All common areas should be regularly cleaned, at least twice daily.
  • Plexiglass barriers should be integrated into cleaning schedule and cleaned daily.
  • Non-essential items should be removed from patient care areas to avoid contamination.

Resources for implementation

These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.

Determining when to schedule in-person vs remote visits - WIP

Last reviewed: June 16, 2020
Last updated: June 16, 2020
Per the Ministry of Health (May 26, 2020), non-essential and elective in-person services carried out by health care providers may be gradually restarted, where appropriate.  

The determination of which services should be provided remotely and which should be provided in-person should be made by healthcare providers guided by best clinical evidence and according to the following four principles (MOH, May 26, 2020):

Proportionality

  • Consider available capacity to provide those services, both real and anticipated.

Minimizing harm to patients

  • Strive to limit harm to patients wherever possible.
  • Activities that have higher implications for morbidity/mortality if delayed too long should be prioritized over those with fewer implications for morbidity/mortality if delayed too long.
  • Consider the differential benefits and burdens to patients and patient populations, as well as available alternatives to relieve pain and suffering.

Equity

  • All persons with the same clinical needs should be treated in the same way unless relevant differences exist (e.g. different levels of clinical urgency).
  • Special attention should be paid to actions that might further disadvantage the already disadvantaged or vulnerable.

Reciprocity

  • Certain patients and patient populations will be particularly burdened as a result of our health system’s limited capacity to restart services.
  • The health system has an obligation to ensure that those who continue to be burdened have their health monitored, receive appropriate care, and be re-evaluated for emergent activities should they require them.
Clinical scenarios

That can be safely assessed and treated remotely (Virtual Care Playbook, CMA, 2020):

  • Mental health issues.
  • Skin problems (have patient submit photos in advance as resolution is much better than a high-quality video camera).
  • Urinary, sinus and minor skin infections (pharyngitis too if you can arrange throat swabs).
  • Sexual health care, including screening and treatment for sexually transmitted infections, and hormonal/oral contraception.
  • Travel medicine.
  • Conditions monitored with home devices and/or lab tests (e.g., hypertension, lipid management, thyroid conditions and some diabetes care; in-person consultations will still be needed for some exam elements).
  • Lab, imaging and specialist reports.
  • Other assessments that do not require palpation or auscultation.

That may warrant an in-person visit (OCFP, March 26, 2020):

Putting it into practice

All healthcare settings are encouraged to switch to virtual visits whenever possible. This decision should be based on an assessment of patient frailty in combination with self-management capability, in terms of both health and technological literacy, as well as technology access.

  • Does the patient have a phone or internet at home?
  • If the patient has access to internet, are they comfortable downloading and using apps, following links, watching videos, downloading attachments, taking and sending photos and videos?
Virtual self-management capacity

Sample prioritization of primary care services

Putting it into practice
Determining when to schedule in-person vs remote visits
Sample prioritization of primary care services

Transitions from one phase to the next should depend on stages of provincial re-opening, office readiness, and community COVID-19 prevalence.

When businesses and schools reopen

  • Acute or subacute symptoms
  • Potentially unstable chronic disease, such as post-myocardial infarction, post-stroke, congestive heart failure (CHF), uncontrolled diabetes, cancer
  • Severe or unstable mental health diagnoses
  • Pre-existing developmental concerns among infants / children
  • Pregnancy and newborn care
  • Mental Health visits, if concerned destabilization will result without in-person visit
  • Other matters presenting risk, for example addiction, at-risk sexual practices
  • IUD insertion/removal, endometrial biopsy
  • Skin biopsies (for suspected melanoma)
  • Injections (anti-psychotics, Depo-Provera, Prolia, methotrexate, etc)
  • Adult vaccines (Prevnar/Pneumovax)
  • Joint injections for chronic/acute pain
  • Allergy shots (if office space allows)
  • Suture removal
  • Palliative care visits (office or home)
  • MAID requests
  • Driver’s Medicals/3rd party medicals for essential service workers

When pandemic epidemiology is stable

  • Chronic symptoms
  • Well infant / child visits
  • Contraception
  • Chronic diseases previously well controlled, requiring interval follow-up (diabetes, hypertension, renal insufficiency, stable CHF, mental health diagnoses)
  • Adult immunizations (routine Shingrix, Tdap, etc)
  • Driver’s Medicals/3rd party medicals for non-essential services
  • Pap smears for follow-up of prior abnormal
  • Mental Health (routine visits)
  • ENT, cardiac, GU non-urgent issues requiring exam
  • Deaf or vulnerable patients unable to have virtual visits (if non-urgent concern)
  • Skin exams if photo/video insufficient
  • Skin biopsies (for non-melanoma lesions)
  • Liquid nitrogen treatments (warts, AKs)

When pandemic epidemiology is stable, physical distancing requirements are lifted, most activities have returned to normal

  • Blood pressure checks for those without chronic disease
  • Sexually transmitted infection screening in average risk individuals
  • Cancer screening: cervix and colon, then breast
    • For cervical cancer screening in individuals without a history of abnormal lesions there is no rush to do a Pap test even if it has been a bit more than 3 years. Some countries do Pap tests every five years, with no difference in cervical cancer mortality (Milbank Quarterly, 2012).
    • For breast screening, considering low effect size of screening and CTFPHC recommendation for 2-3 year screening, this could wait until 3 years (CTFPHC, 2018).
  • Meet and greets for new patients
  • Routine PAP
  • Periodic/Preventative Care Reviews
  • B12 injections
  • Diabetic checks
  • Hypertension review
  • Stable CHF/COPD visits
  • Contraception review
  • STI screening
  • Smoking cessation

When capacity exists

  • Patient-initiated health promotion

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Used when conveying REALLY important information that applies to the whole population, high risks, red flags, gov’t requirements, etc.  The point of use is to make the user STOP and read.  So we tended to use it sparingly otherwise the impact of the icon will be diluted.

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  • Any persons experiencing one of the following should be told to self-isolate and tested as soon as possible:
    • Fever (temperature of 37.8°C or greater)
    • New/worsening cough
    • Shortness of breath (dyspnea)
    • Sore throat
    • Difficulty swallowing
    • New olfactory or taste disorder(s)
    • Nausea/vomiting, diarrhea, abdominal pain
    • Runny nose, or nasal congestion (in absence of underlying reason for these symptoms such as seasonal allergies, post nasal drip, etc.)
  • There is only low-quality evidence available on COVID-19, as it is an emerging virus. Many studies being released have not been peer-reviewed. Among those that have been peer-reviewed, many are small, retrospective observational studies and thus have serious limitations and risks of bias. While the findings of emerging COVID-19 studies can be useful in helping to broaden our understanding about how the virus might operate, the results of COVID-19 studies should not be considered validated.
  • As reports of children experiencing a multi-system inflammatory syndrome multiply, the Canadian Paediatric Surveillance Program issued a Public Health Alert (CPSP, May 12, 2020) encouraging those providing paediatric care to familiarize themselves with the presentations of this emerging syndrome. It has now been included in the case definition and is reportable to public health.

Generally used when conveying information that applies to the part of the population, things that are “strongly recommended” but maybe not yet mandated, cautions, etc. Similar criteria as the (!) icon, but with a content that isn’t quite as MUST READ. The point of use is to make the user PAUSE and read.  Used more frequently.

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  • OCFP and CFPC suggest strongly considering PPE use for all patient encounters that involve less than 6 feet of separation due to the possibility of asymptomatic and pre-symptomatic transmission. For more information on PPE, see Infection prevention and control: PPE, HCW infection control, cleaning.
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  • Responding to questions about unproven therapies for COVID-19: “Though research is underway, there are currently no medications recommended for preventing or treating COVID-19 because there is not enough evidence to make any conclusions yet” (CMAJ, 2020).
  • “This is your home and we will make every effort to make you comfortable in your new room with all of your belongings.”
  • “In-room dining is important for you and other residents so that we can protect everyone, including yourself.”
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Table with Icon

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

FAQ/info block

Answer 1

Answer 2

Answer 3

Another “click to reveal” block. commonly used for FAQs, chronic diseasae mgmt, special pops, etc. For example:

Please note the content contained within the answer is NOT searchable using the search function.

Stack of papers. Multiple Choice
Option 1
can have multiple rows within section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

can have multiple rows within section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

can have multiple rows within section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Option 2
can have multiple rows within section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

can have multiple rows within section

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec non maximus tellus, at tristique velit. Aliquam interdum arcu orci, id congue lacus elementum ac. Phasellus congue aliquam lectus sed porta. Morbi turpis tellus, pharetra fermentum consectetur sollicitudin, viverra pretium ex. Quisque consectetur faucibus felis et varius. Nulla mattis maximus dolor, in consequat est pulvinar ac. Pellentesque eleifend eu tortor et cursus. Integer iaculis quis sapien congue commodo. Proin ullamcorper posuere eros, nec ultrices odio elementum aliquam. Aliquam erat volutpat.

Takes up a lot of page “real estate”. We tend to NOT use unless there are multiple Y/N questions/use of block consistently. For example, see: COVID-19: Social Care Guidance. Please note the content contained within the answer is NOT searchable using the search function.

Card block

We use this block when displaying similar information that has consistent headings/categories. It was originally developed to contain rx info. Allows us to use horizontal real estate and not overload the vertical/infinite scroll issue. Also gives provides opportunity to add additional information with each card that pops out for more details. Mobile friendly. Searchable in search function. For example:

Pop-out block

Designed for talking tips, etc. Generally used to contain information that is not necessarily immediately relevant for all users. But, for those that are interested, they can click to “opt-in” to view the content. Content is NOT searchable using the search function. For example:

Image block

Used for images of diagrams, static flow charts, evidence tables that go beyond three columns, etc. Please note, if we can we try NOT to use images for evidence tables are they do not render well in mobile. Where possible, consider how the content can be summarized differently/more succiently before going down the image route. For example:

Red Flags

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["Fingerprint"]
["Fingerprint"]
['50096438']
['50096438']
["Fingerprint"]
["Fingerprint"]
['50074653']
['50074653']
["Fingerprint"]
["Fingerprint"]
['50074653']
['50074653']