Draft a telehealth intake form's questions so triage staff get answers they can actually act on

You are drafting the question set for a telehealth intake form for one specific visit type. The form needs to produce answers precise enough for triage staff to act on, not vague enough that a nurse has to call the patient back to ask what they actually meant.

VISIT TYPE
Same-day telehealth visit for a new skin rash.

WHAT TRIAGE STAFF NEED TO KNOW TO ROUTE THIS CORRECTLY
Need to know rash location, spread rate, whether there's fever, and whether the patient has any known allergy history.

SYMPTOMS OR SITUATIONS THAT SHOULD TRIGGER AN URGENT FLAG
Difficulty breathing, swelling of the face or throat, rash spreading rapidly within hours, or high fever.

EXISTING FORM FIELDS TO KEEP (if any)
Keep the existing insurance and pharmacy fields unchanged.

PATIENT POPULATION
General adult population, form needs to be usable on a phone, some patients may be filling it out for a child.

RULES
Write each question so the possible answers are specific enough to act on — prefer a structured choice (severity scale, duration bucket, yes/no with a specific follow-up) over an open free-text box for anything triage staff need to make a routing decision from, and reserve free text for things that genuinely can't be pre-structured ("anything else we should know"). Build explicit branching: state which answer to which question should trigger the urgent-flag path, and write the on-screen message the patient sees when that path triggers, directing them to call emergency services or a specific urgent line rather than simply submitting the form and waiting. Order the questions so anything relevant to the urgent-flag criteria appears early, not buried after a long series of demographic or insurance questions, so a patient in real distress doesn't have to complete unrelated fields first. Do not write a question that requires the patient to already know clinical terminology to answer correctly — describe what to look for in plain terms, not the name of the sign a clinician would use for it.

WHAT NOT TO DO
Do not write questions or branching logic that would let the form itself render a diagnosis or a treatment recommendation to the patient — the form's only job is to gather structured information and flag urgency; every non-urgent path should end in "this will be reviewed by your care team," not a suggested diagnosis or plan.

MANDATORY DISCLAIMER
Add a line, both to the practice and as on-screen text for the patient, stating that this intake form does not replace an emergency evaluation, that anyone experiencing a flagged urgent symptom should seek immediate care rather than waiting for form review, and that the full question set and urgent-flag logic must be reviewed and approved by clinical staff before this form is used with real patients.

OUTPUT FORMAT
1. The disclaimer.
2. The ordered question list, each with its answer format (structured choice options listed, or free text).
3. The branching logic table: trigger answer -> urgent flag -> patient-facing message shown.
4. A short note to clinical staff on what they specifically need to review before go-live.