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Protocol - Immunizations

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Description:

This protocol is a self- or proxy-administered questionnaire from the American Health Information Management Association (AHIMA) that collects information on the age and date at which a respondent was immunized for specific diseases.

Protocol:

A. Immunizations

 

Booster 1

Booster 2

Booster 3

Immunization for

Age

Date

Age

Date

Age

Date

Diphtheria

           

Hepatitis B

           

Measles

           

Mumps

           

Pertussis/

Whooping Cough

           

Polio

           

Rubella

           

Smallpox

           

Tetanus

           

Tuberculosis

           

Typhoid

           

Other

 

         

 

           

 

           
Protocol Name from Source:

The Expert Review Panel has not reviewed this measure yet.

Availability:

Publicly available

Personnel and Training Required

None

Equipment Needs

None

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self- or proxy-administered questionnaire

Life Stage:

Infant, Toddler, Child, Adolescent, Adult, Senior, Pregnancy

Participants:

Any age group

Specific Instructions:

The Infectious Diseases and Immunity Working Group (WG) recommends that when choosing this protocol, please also refer to the Centers for Disease Control and Prevention's (CDC's) annually updated list of immunizations recommended by the Advisory Committee on Immunization Practices.

The Infectious Diseases and Immunity WG also recommends that, for older adults, medical records from a participant's physician may be necessary to provide this information.

Selection Rationale

The American Health Information Management Association's (AHIMA's) My Personal Health Record (MyPHR) protocol is a national program used by several state health information management associations in community-based settings.

Language

English, Spanish

Standards
StandardNameIDSource
Common Data Elements (CDE) Adult Immunization Personal Medical History Assessment Description Text 3151222 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Immunizations proto 62884-2 LOINC
Derived Variables

None

Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

American Health Information Management Association (AHIMA). My Personal Health Record (MyPHR). Adult PHR Form 2006, Section H.

General References

None

Protocol ID:

161001

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX161001_Diphtheria_Booster_1_Age PX161001010100 Diphtheria Booster 1 Age 4 N/A
PX161001_Diphtheria_Booster_1_Date_Day PX161001010201 Diphtheria Booster 1 Date - Day 4 N/A
PX161001_Diphtheria_Booster_1_Date_Month PX161001010202 Diphtheria Booster 1 Date - Month 4 N/A
PX161001_Diphtheria_Booster_1_Date_Year PX161001010203 Diphtheria Booster 1 Date - Year 4 N/A
PX161001_Diphtheria_Booster_2_Age PX161001010300 Diphtheria Booster 2 Age 4 N/A
PX161001_Diphtheria_Booster_2_Date_Day PX161001010401 Diphtheria Booster 2 Date - Day 4 N/A
PX161001_Diphtheria_Booster_2_Date_Month PX161001010402 Diphtheria Booster 2 Date - Month 4 N/A
PX161001_Diphtheria_Booster_2_Date_Year PX161001010403 Diphtheria Booster 2 Date - Year 4 N/A
PX161001_Diphtheria_Booster_3_Age PX161001010500 Diphtheria Booster 3 Age 4 N/A
PX161001_Diphtheria_Booster_3_Date_Day PX161001010601 Diphtheria Booster 3 Date - Day 4 N/A
PX161001_Diphtheria_Booster_3_Date_Month PX161001010602 Diphtheria Booster 3 Date - Month 4 N/A
PX161001_Diphtheria_Booster_3_Date_Year PX161001010603 Diphtheria Booster 3 Date - Year 4 N/A
PX161001_Hepatitis_B_Booster_1_Age PX161001020100 Hepatitis B Booster 1 Age 4 N/A
PX161001_Hepatitis_B_Booster_1_Date_Day PX161001020201 Hepatitis B Booster 1 Date - Day 4 N/A
PX161001_Hepatitis_B_Booster_1_Date_Month PX161001020202 Hepatitis B Booster 1 Date - Month 4 N/A
PX161001_Hepatitis_B_Booster_1_Date_Year PX161001020203 Hepatitis B Booster 1 Date - Year 4 N/A
PX161001_Hepatitis_B_Booster_2_Age PX161001020300 Hepatitis B Booster 2 Age 4 N/A
PX161001_Hepatitis_B_Booster_2_Date_Day PX161001020401 Hepatitis B Booster 2 Date - Day 4 N/A
PX161001_Hepatitis_B_Booster_2_Date_Month PX161001020402 Hepatitis B Booster 2 Date - Month 4 N/A
PX161001_Hepatitis_B_Booster_2_Date_Year PX161001020403 Hepatitis B Booster 2 Date - Year 4 N/A
PX161001_Hepatitis_B_Booster_3_Age PX161001020500 Hepatitis B Booster 3 Age 4 N/A
PX161001_Hepatitis_B_Booster_3_Date_Day PX161001020601 Hepatitis B Booster 3 Date - Day 4 N/A
PX161001_Hepatitis_B_Booster_3_Date_Month PX161001020602 Hepatitis B Booster 3 Date - Month 4 N/A
PX161001_Hepatitis_B_Booster_3_Date_Year PX161001020603 Hepatitis B Booster 3 Date - Year 4 N/A
PX161001_Measles_Booster_1_Age PX161001030100 Measles Booster 1 Age 4 N/A
PX161001_Measles_Booster_1_Date_Day PX161001030201 Measles Booster 1 Date - Day 4 N/A
PX161001_Measles_Booster_1_Date_Month PX161001030202 Measles Booster 1 Date - Month 4 N/A
PX161001_Measles_Booster_1_Date_Year PX161001030203 Measles Booster 1 Date - Year 4 N/A
PX161001_Measles_Booster_2_Age PX161001030300 Measles Booster 2 Age 4 N/A
PX161001_Measles_Booster_2_Date_Day PX161001030401 Measles Booster 2 Date - Day 4 N/A
PX161001_Measles_Booster_2_Date_Month PX161001030402 Measles Booster 2 Date - Month 4 N/A
PX161001_Measles_Booster_2_Date_Year PX161001030403 Measles Booster 2 Date - Year 4 N/A
PX161001_Measles_Booster_3_Age PX161001030500 Measles Booster 3 Age 4 N/A
PX161001_Measles_Booster_3_Date_Day PX161001030601 Measles Booster 3 Date - Day 4 N/A
PX161001_Measles_Booster_3_Date_Month PX161001030602 Measles Booster 3 Date - Month 4 N/A
PX161001_Measles_Booster_3_Date_Year PX161001030603 Measles Booster 3 Date - Year 4 N/A
PX161001_Mumps_Booster_1_Age PX161001040100 Mumps Booster 1 Age 4 N/A
PX161001_Mumps_Booster_1_Date_Day PX161001040201 Mumps Booster 1- Date - Day 4 N/A
PX161001_Mumps_Booster_1_Date_Month PX161001040202 Mumps Booster 1 - Date- Month 4 N/A
PX161001_Mumps_Booster_1_Date_Year PX161001040203 Mumps Booster 1 - Date- Year 4 N/A
PX161001_Mumps_Booster_2_Age PX161001040300 Mumps Booster 2 Age 4 N/A
PX161001_Mumps_Booster_2_Date_Day PX161001040401 Mumps Booster 2- Date - Day 4 N/A
PX161001_Mumps_Booster_2_Date_Month PX161001040402 Mumps Booster 2 - Date- Month 4 N/A
PX161001_Mumps_Booster_2_Date_Year PX161001040403 Mumps Booster 2 - Date- Year 4 N/A
PX161001_Mumps_Booster_3_Age PX161001040500 Mumps Booster 3 Age 4 N/A
PX161001_Mumps_Booster_3_Date_Day PX161001040601 Mumps Booster 3 - Date - Day 4 N/A
PX161001_Mumps_Booster_3_Date_Month PX161001040602 Mumps Booster 3 - Date- Month 4 N/A
PX161001_Mumps_Booster_3_Date_Year PX161001040603 Mumps Booster 3 - Date- Year 4 N/A
PX161001_Other_Booster_1_Age PX161001120100 Other Booster 1 Age 4 N/A
PX161001_Other_Booster_1_Date_Day PX161001120201 Other Booster 1 Date - Day 4 N/A
PX161001_Other_Booster_1_Date_Month PX161001120202 Other Booster 1 Date - Month 4 N/A
PX161001_Other_Booster_1_Date_Year PX161001120203 Other Booster 1 Date - Year 4 N/A
PX161001_Other_Booster_2_Age PX161001120300 Other Booster 2 Age 4 N/A
PX161001_Other_Booster_2_Date_Day PX161001120401 Other Booster 2 Date - Day 4 N/A
PX161001_Other_Booster_2_Date_Month PX161001120402 Other Booster 2 Date - Month 4 N/A
PX161001_Other_Booster_2_Date_Year PX161001120403 Other Booster 2 Date - Year 4 N/A
PX161001_Other_Booster_3_Age PX161001120500 Other Booster 3 Age 4 N/A
PX161001_Other_Booster_3_Date_Day PX161001120601 Other Booster 3 Date - Day 4 N/A
PX161001_Other_Booster_3_Date_Month PX161001120602 Other Booster 3 Date - Month 4 N/A
PX161001_Other_Booster_3_Date_Year PX161001120603 Other Booster 3 Date - Year 4 N/A
PX161001_Other_Booster_Specify PX161001120000 Other Booster, specify 4 N/A
PX161001_Pertussis/WhoopingCough_Booster_1_Date_Day PX161001050201 Pertussis/Whooping Cough Booster 1 Date - Day 4 N/A
PX161001_Pertussis/WhoopingCough_Booster_1_Date_Month PX161001050202 Pertussis/Whooping Cough Booster 1 Date - Month 4 N/A
PX161001_Pertussis/WhoopingCough_Booster_1_Date_Year PX161001050203 Pertussis/Whooping Cough Booster 1 Date - Year 4 N/A
PX161001_Pertussis/WhoopingCough_Booster_2_Date_Day PX161001050401 Pertussis/Whooping Cough Booster 2 Date - Day 4 N/A
PX161001_Pertussis/WhoopingCough_Booster_2_Date_Month PX161001050402 Pertussis/Whooping Cough Booster 2 Date - Month 4 N/A
PX161001_Pertussis/WhoopingCough_Booster_2_Date_Year PX161001050403 Pertussis/Whooping Cough Booster 2 Date - Year 4 N/A
PX161001_Pertussis/WhoopingCough_Booster_3_Date_Day PX161001050601 Pertussis/Whooping Cough Booster 3 Date - Day 4 N/A
PX161001_Pertussis/WhoopingCough_Booster_3_Date_Month PX161001050602 Pertussis/Whooping Cough Booster 3 Date - Month 4 N/A
PX161001_Pertussis/WhoopingCough_Booster_3_Date_Year PX161001050603 Pertussis/Whooping Cough Booster 3 Date - Year 4 N/A
PX161001_Pertussis/Whooping_Cough_Booster_1_Age PX161001050100 Pertussis/Whooping Cough Booster 1 Age 4 N/A
PX161001_Pertussis/Whooping_Cough_Booster_2_Age PX161001050300 Pertussis/Whooping Cough Booster 2 Age 4 N/A
PX161001_Pertussis/Whooping_Cough_Booster_3_Age PX161001050500 Pertussis/Whooping Cough Booster 3 Age 4 N/A
PX161001_Polio_Booster_1_Age PX161001060100 Polio Booster 1 Age 4 N/A
PX161001_Polio_Booster_1_Date_Day PX161001060201 Polio Booster 1 Date - Day 4 N/A
PX161001_Polio_Booster_1_Date_Month PX161001060202 Polio Booster 1 Date -Month 4 N/A
PX161001_Polio_Booster_1_Date_Year PX161001060203 Polio Booster 1 Date - Year 4 N/A
PX161001_Polio_Booster_2_Age PX161001060300 Polio Booster 2 Age 4 N/A
PX161001_Polio_Booster_2_Date_Day PX161001060401 Polio Booster 2 Date - Day 4 N/A
PX161001_Polio_Booster_2_Date_Month PX161001060402 Polio Booster 2 Date -Month 4 N/A
PX161001_Polio_Booster_2_Date_Year PX161001060403 Polio Booster 2 Date - Year 4 N/A
PX161001_Polio_Booster_3_Age PX161001060500 Polio Booster 3 Age 4 N/A
PX161001_Polio_Booster_3_Date_Day PX161001060601 Polio Booster 3 Date - Day 4 N/A
PX161001_Polio_Booster_3_Date_Month PX161001060602 Polio Booster 3 Date -Month 4 N/A
PX161001_Polio_Booster_3_Date_Year PX161001060603 Polio Booster 3 Date - Year 4 N/A
PX161001_Rubella_Booster_1_Age PX161001070100 Rubella Booster 1 Age 4 N/A
PX161001_Rubella_Booster_1_Date_Day PX161001070201 Rubella Booster 1 Date - Day 4 N/A
PX161001_Rubella_Booster_1_Date_Month PX161001070202 Rubella Booster 1 Date - Month 4 N/A
PX161001_Rubella_Booster_1_Date_Year PX161001070203 Rubella Booster 1 Date - Year 4 N/A
PX161001_Rubella_Booster_2_Age PX161001070300 Rubella Booster 2 Age 4 N/A
PX161001_Rubella_Booster_2_Date_Day PX161001070401 Rubella Booster 2 Date - Day 4 N/A
PX161001_Rubella_Booster_2_Date_Month PX161001070402 Rubella Booster 2 Date - Month 4 N/A
PX161001_Rubella_Booster_2_Date_Year PX161001070403 Rubella Booster 2 Date - Year 4 N/A
PX161001_Rubella_Booster_3_Age PX161001070500 Rubella Booster 3 Age 4 N/A
PX161001_Rubella_Booster_3_Date_Day PX161001070601 Rubella Booster 3 Date - Day 4 N/A
PX161001_Rubella_Booster_3_Date_Month PX161001070602 Rubella Booster 3 Date - Month 4 N/A
PX161001_Rubella_Booster_3_Date_Year PX161001070603 Rubella Booster 3 Date - Year 4 N/A
PX161001_Smallpox_Booster_1_Age PX161001080100 Smallpox Booster 1 Age 4 N/A
PX161001_Smallpox_Booster_1_Date_Day PX161001080201 Smallpox Booster 1 Date - Day 4 N/A
PX161001_Smallpox_Booster_1_Date_Month PX161001080202 Smallpox Booster 1 Date - Month 4 N/A
PX161001_Smallpox_Booster_1_Date_Year PX161001080203 Smallpox Booster 1 Date - Year 4 N/A
PX161001_Smallpox_Booster_2_Age PX161001080300 Smallpox Booster 2 Age 4 N/A
PX161001_Smallpox_Booster_2_Date_Day PX161001080401 Smallpox Booster 2 Date - Day 4 N/A
PX161001_Smallpox_Booster_2_Date_Month PX161001080402 Smallpox Booster 2 Date - Month 4 N/A
PX161001_Smallpox_Booster_2_Date_Year PX161001080403 Smallpox Booster 2 Date - Year 4 N/A
PX161001_Smallpox_Booster_3_Age PX161001080500 Smallpox Booster 3 Age 4 N/A
PX161001_Smallpox_Booster_3_Date_Day PX161001080601 Smallpox Booster 3 Date - Day 4 N/A
PX161001_Smallpox_Booster_3_Date_Month PX161001080602 Smallpox Booster 3 Date - Month 4 N/A
PX161001_Smallpox_Booster_3_Date_Year PX161001080603 Smallpox Booster 3 Date - Year 4 N/A
PX161001_Tetanus_Booster_1_Age PX161001090100 Tetanus Booster 1 Age 4 N/A
PX161001_Tetanus_Booster_1_Date_Day PX161001090201 Tetanus Booster 1 Date - Day 4 N/A
PX161001_Tetanus_Booster_1_Date_Month PX161001090202 Tetanus Booster 1 Date - Month 4 N/A
PX161001_Tetanus_Booster_1_Date_Year PX161001090203 Tetanus Booster 1 Date - Year 4 N/A
PX161001_Tetanus_Booster_2_Age PX161001090300 Tetanus Booster 2 Age 4 N/A
PX161001_Tetanus_Booster_2_Date_Day PX161001090401 Tetanus Booster 1 Date - Day 4 N/A
PX161001_Tetanus_Booster_2_Date_Month PX161001090402 Tetanus Booster 2 Date - Month 4 N/A
PX161001_Tetanus_Booster_2_Date_Year PX161001090403 Tetanus Booster 2 Date - Year 4 N/A
PX161001_Tetanus_Booster_3_Age PX161001090500 Tetanus Booster 3 Age 4 N/A
PX161001_Tetanus_Booster_3_Date_Day PX161001090601 Tetanus Booster 3 Date - Day 4 N/A
PX161001_Tetanus_Booster_3_Date_Month PX161001090602 Tetanus Booster 3 Date - Month 4 N/A
PX161001_Tetanus_Booster_3_Date_Year PX161001090603 Tetanus Booster 3 Date - Year 4 N/A
PX161001_Tuberculosis_Booster_1_Age PX161001100100 Tuberculosis Booster 1 Age 4 N/A
PX161001_Tuberculosis_Booster_1_Date_Day PX161001100201 Tuberculosis Booster 1 Date - Day 4 N/A
PX161001_Tuberculosis_Booster_1_Date_Month PX161001100202 Tuberculosis Booster 1 Date - Month 4 N/A
PX161001_Tuberculosis_Booster_1_Date_Year PX161001100203 Tuberculosis Booster 1 Date - Year 4 N/A
PX161001_Tuberculosis_Booster_2_Age PX161001100300 Tuberculosis Booster 2 Age 4 N/A
PX161001_Tuberculosis_Booster_2_Date_Day PX161001100401 Tuberculosis Booster 2 Date - Day 4 N/A
PX161001_Tuberculosis_Booster_2_Date_Month PX161001100402 Tuberculosis Booster 2 Date - Month 4 N/A
PX161001_Tuberculosis_Booster_2_Date_Year PX161001100403 Tuberculosis Booster 2 Date - Year 4 N/A
PX161001_Tuberculosis_Booster_3_Age PX161001100500 Tuberculosis Booster 3 Age 4 N/A
PX161001_Tuberculosis_Booster_3_Date_Day PX161001100601 Tuberculosis Booster 3 Date - Day 4 N/A
PX161001_Tuberculosis_Booster_3_Date_Month PX161001100602 Tuberculosis Booster 3 Date - Month 4 N/A
PX161001_Tuberculosis_Booster_3_Date_Year PX161001100603 Tuberculosis Booster 3 Date - Year 4 N/A
PX161001_Typhoid_Booster_1_Age PX161001110100 Typhoid Booster 1 Age 4 N/A
PX161001_Typhoid_Booster_1_Date_Day PX161001110201 Typhoid Booster 1 Date - Day 4 N/A
PX161001_Typhoid_Booster_1_Date_Month PX161001110202 Typhoid Booster 1 Date - Month 4 N/A
PX161001_Typhoid_Booster_1_Date_Year PX161001110203 Typhoid Booster 1 Date - Year 4 N/A
PX161001_Typhoid_Booster_2_Age PX161001110300 Typhoid Booster 2 Age 4 N/A
PX161001_Typhoid_Booster_2_Date_Day PX161001110401 Typhoid Booster 2 Date - Day 4 N/A
PX161001_Typhoid_Booster_2_Date_Month PX161001110402 Typhoid Booster 2 Date - Month 4 N/A
PX161001_Typhoid_Booster_2_Date_Year PX161001110403 Typhoid Booster 2 Date - Year 4 N/A
PX161001_Typhoid_Booster_3_Age PX161001110500 Typhoid Booster 3 Age 4 N/A
PX161001_Typhoid_Booster_3_Date_Day PX161001110601 Typhoid Booster 3 Date - Day 4 N/A
PX161001_Typhoid_Booster_3_Date_Month PX161001110602 Typhoid Booster 3 Date - Month 4 N/A
PX161001_Typhoid_Booster_3_Date_Year PX161001110603 Typhoid Booster 3 Date - Year 4 N/A
Research Domain Information
Measure Name:

Immunizations

Release Date:

November 12, 2010

Definition

This measure is a questionnaire to collect information on a respondent's personal medical history of immunizations.

Purpose

This measure can be used to establish a respondent's history of immunizations.

Keywords

Immunization, Vaccine, Infectious Diseases, American Health Information Management Association, AHIMA, My Personal Health Record, MyPHR, Infectious Diseases and Immunity