Patient symptom checklist with associated severity for those present
Patient baseline and quarterly surveys, None, Mild, Moderate, Severe
If symptom is present, has patient experienced this in the past month
Patient baseline and quarterly surveys, Yes/No
If symptom is present, how long has patient experienced this symptom
Patient baseline and quarterly surveys, Under 3 Months, 3 Months or longer
If symptom is present, did patient have this symptom before the patient tested positive for COVID-19?
Patient baseline and quarterly surveys, Yes/No
If symptom is present, during the past month how often have the patient had this symptom?
Patient baseline and quarterly surveys with use of Likert scale
If symptom is present during the past month, how bad was this symptom?
Patient baseline and quarterly surveys with use of Likert scale
For symptoms present, do any of them get worse for at least 24 hours after engaging in activities (physical or mental) that patient was used to doing with no problems?
Patient baseline and quarterly surveys with Yes/No/Not Applicable/Don't Know
If fatigue, tiredness, or exhaustion is present, doesn't patient describe it as feeling it come on all of a sudden, or slowly over time
Patient baseline and quarterly surveys with All of sudden, Slowly over time, Not applicable, Don't know
If fatigue present, what month and year did the fatiguing illness begin?
Patient baseline and quarterly surveys, estimated month and year
When fatigued, does rest make patient's fatigue better?
Patient baseline and quarterly surveys, Yes a lot, Yes a little, No not very much, Not applicable, Don't know
When fatigued, has this fatigue substantially limited the patient's ability to occupational, educational, social, or personal activities?
Patient baseline and quarterly surveys, Yes, No, Not applicable, Don't know
Patient's medical history check-list
Patient baseline survey, Yes, No, Unsure
Patient's dietary restrictions
Patient baseline survey, No, Vegan, Vegetarian, Ketogenic, Gluten-free, Dairy-free, Intermittent fasting, Other
Patient's food allergies or other food intolerances
Patient baseline survey, Yes/No
Has patient's employment been impacted due to contracting COVID-19?
Patient baseline survey, Yes, No
Patient's frequency to complete 150-minutes per week of moderate-intensity physical activity (like a brisk walk, slow biking, gardening, or ballroom dancing) prior to contracting COVID-19
Patient baseline survey, Every week, Most weeks, Some weeks, Very few weeks, Never, I do not know
Patient's frequency to complete 150-minutes per week of vigorous-intensity physical activity (like running, swimming laps, competitive sports, or fast bicycling) prior to contracting COVID-19
Patient baseline survey, Every week, Most weeks, Some weeks, Very few weeks, Never, I do not know
Did patient receive a COVID-19 PCR (nasal swab) test
Patient baseline survey, Yes/No
Did patient receive a COVID-19 antibody test
Patient baseline survey, Yes/No
Patient symptom onset
Patient baseline survey, Date
Patient reported medications used for COVID-19 symptoms
Patient baseline survey, free text
Patient reported prescribed supplementary oxygen support
Patient baseline survey, Yes/No
Patient reported admittance to hospital due to COVID-19
Patient baseline and quarterly surveys, Yes/No
Do any of the following activities exacerbate patients symptoms: Physical exertion, Diet Changes, Big Meal, Dehydration, Weather changes (hot and humid), Tight clothing, Stress or anxiety, Pre Menstrual period, Menstrual period, Alcohol consumption
Patient baseline and quarterly surveys, Yes/No
Does patient feel fully recovered from COVID-19
Patient quarterly surveys, Yes/No
Currently minutes per week of moderate-intensity physical activity patient does (like a brisk walk, slow biking, gardening, or ballroom dancing)
Patient quarterly surveys, free text
Currently minutes per week of vigorous-intensity physical activity patient does (like running, swimming laps, competitive sports, or fast bicycling)
Patient quarterly surveys, free text
Patient Health Questionnaire (PHQ)-2
Patient baseline and quarterly surveys
Patient Health Questionnaire (PHQ)-9 (if applicable)
Patient baseline and quarterly surveys
PROMIS Dyspnea Functional Limitations and Severity Short Forms
Patient baseline and quarterly surveys
PROMIS Applied Cognition Abilities and General Concerns Short Forms
Patient baseline and quarterly surveys
Generalized Anxiety Disorder (GAD)-7
Patient baseline and quarterly surveys
2-minute step test
Physical Therapy assessment with patient
30 sec sit to stand test
Physical Therapy assessment with patient
Grip strength
Physical Therapy assessment with patient
Functional Gait Assessment
Physical Therapy assessment with patient
Balance tasks
Physical Therapy assessment with patient
Post-exertional malaise follow-up
Follow-up Physical Therapy appointment with patient, Not at all, A little bit, Somewhat, Quite a bit, Very much