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Clinical Resources

Standardized Data Collection Tools:

“Long COVID-19 Questionnaire” CPRS Template

This template was developed by the Long COVID-19 Integrated Project Team (IPT) as a standardized process for identifying Long COVID patients as well as assessing symptoms and treatment for Long COVID. This template is available in CPRS and can be used by any VA provider. The questionnaire takes approximately 45 minutes to complete. This questionnaire as well as consult templates mentioned below may need to be installed by your facility. If you do not see these templates available in CPRS, please contact your local Clinical Applications Coordinator (CAC) to request installation.

The survey can be completed virtually or in-person and includes:

  • Whole Health
  • Modified Yorkshire (completed within Mental Health Assistant (MHA Web), further instructions can be found below)
  • Well-Being Signs
  • Exercise Vital Signs Questionnaire
  • 2-minute Step Test

Instructions on using this template can be found here: LongCOVIDQuestionnaireTemplateUserGuide.pptx

Additional questions about the template and its use can be sent to
vhalongCOVID-19projectsupportteam@va.gov.

Accessing the Modified Yorkshire via MHA Web:

  1. Open CPRS
  2. Click Tools on the CPRS toolbar
  3. Select Specialty Applications
  4. Select MHA Web
  5. Select Location
  6. New Assignment
    1. Select “+” sign from the MHA Web Toolbar and select VA Device/Staff Entry
    2. Under the Long COVID Section select C19-YRS (Yorkshire)
Mental Health Assistant Mental Health Assistant 2

Additional surveys are also available in MHA Web:

  • EQ-5D-5L
  • FSS
  • MIDAS
  • MRC
  • PCFS
  • PEG

CPRS Consult Templates for Long COVID:

“Long COVID Whole Health MD Initial Consult “

  • This consult template will populate the Long COVID-19 Consult Response
  • Includes questions on symptoms and free text fields to describing changes in symptoms over time.
  • Answers are stored as health factors that can be identified in CDW

“Long COVID Outreach” Note

  • Used after clinics receives the consult
  • This contact can be used to complete the Long COVID-19 Questionnaire

Additional Clinical Guidance:

Guides currently in progress:


Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.