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Protocol - Personal Medical History of Allergies, Infectious Diseases, and Immunizations - Child

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Description:

This protocol is a proxy-administered personal health record from the American Health Information Management Association (AHIMA). The parent or guardian is asked to provide details on the child in the following categories: Birth, Health Log, Allergies/Drug Sensitivities, Infectious Disease, and Immunizations.

Protocol:

A. Birth

Hospital


Height


Length


Doctor


Prenatal Problem


Apgar Score


B. Health Log

Date

Health Problem

Remarks
(e.g., medications, special tests, x-rays, length of hospital stay, surgery)

 

 

 

 

 

 

 

 

 

C. Allergies/Drug Sensitivities

Allergy/Sensitivity Type
(include medications, foods, environmental, or other)

Reaction

Date Last Occurred

Treatment

 

 

 

 

 

 

 

 

 

 

 

 

D. Infectious Disease

Disease

Age

Date

Remarks

Chicken Pox

     

Measles

     

Rubella

     

Hepatitis

     

Pertussis/Whooping Cough

     

Pneumonia

     

Polio

     

Mumps

     

Scarlet Fever

     

Other

     

E. Immunizations

  BOOSTER 1 BOOSTER 2 BOOSTER 3

Immunizations

AGE

DATE

AGE

DATE

AGE

DATE

Diphtheria

           

Pertussis/Whooping Cough

           

Tetanus

           

Smallpox

           

Typhoid

           

Rubella

           

Mumps

           

Measles

           

Tuberculosis

           

Hepatitis B

           

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

Proxy-administered questionnaire

Life Stage:

Infant, Child, Adolescent

Participants:

Infants, children, and teenagers, aged under 18 years old.

Specific Instructions:

None

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) Child Immunization Personal Medical History Assessment Description Text 3151223 CDE Browser
Common Data Elements (CDE) Child Infectious Disorder Personal Medical History Assessment Description Text 3151230 CDE Browser
Common Data Elements (CDE) Child Hypersensitivity Personal Medical History Assessment Description Text 3151231 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Hx allerg infect immun child proto 62894-1 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). Child PHR Form 2006. Sections B,C, D, F, G.

General References

None

Protocol ID:

161601

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX161601_Allergy/Sensitivity1_Date_Last_Occurred_Day PX161601030104 Allergy/Sensitivity 1 - Date Last Occurred - Day 4 N/A
PX161601_Allergy/Sensitivity1_Date_Last_Occurred_Month PX161601030103 Allergy/Sensitivity 1 - Date Last Occurred - Month 4 N/A
PX161601_Allergy/Sensitivity1_Date_Last_Occurred_Year PX161601030105 Allergy/Sensitivity 1 - Date Last Occurred - Year 4 N/A
PX161601_Allergy/Sensitivity1_Reaction PX161601030102 Allergy/Sensitivity 1 - Reaction 4 N/A
PX161601_Allergy/Sensitivity1_Treatment PX161601030106 Allergy/Sensitivity 1 - Treatment 4 N/A
PX161601_Allergy/Sensitivity1_Type PX161601030101 Allergy/Sensitivity 1 - Type (include medications, foods, environmental, or other) 4 N/A
PX161601_Allergy/Sensitivity2_Date_Last_Occurred_Day PX161601030204 Allergy/Sensitivity 2 - Date Last Occurred - Day 4 N/A
PX161601_Allergy/Sensitivity2_Date_Last_Occurred_Month PX161601030203 Allergy/Sensitivity 2 - Date Last Occurred - Month 4 N/A
PX161601_Allergy/Sensitivity2_Date_Last_Occurred_Year PX161601030205 Allergy/Sensitivity 2 - Date Last Occurred - Year 4 N/A
PX161601_Allergy/Sensitivity2_Reaction PX161601030202 Allergy/Sensitivity 2 - Reaction 4 N/A
PX161601_Allergy/Sensitivity2_Treatment PX161601030206 Allergy/Sensitivity 2 - Treatment 4 N/A
PX161601_Allergy/Sensitivity2_Type PX161601030201 Allergy/Sensitivity 2 - Type (include medications, foods, environmental, or other) 4 N/A
PX161601_Allergy/Sensitivity3_Date_Last_Occurred_Day PX161601030304 Allergy/Sensitivity 3 - Date Last Occurred - Day 4 N/A
PX161601_Allergy/Sensitivity3_Date_Last_Occurred_Month PX161601030303 Allergy/Sensitivity 3 - Date Last Occurred - Month 4 N/A
PX161601_Allergy/Sensitivity3_Date_Last_Occurred_Year PX161601030305 Allergy/Sensitivity 3 - Date Last Occurred - Year 4 N/A
PX161601_Allergy/Sensitivity3_Reaction PX161601030302 Allergy/Sensitivity 3 - Reaction 4 N/A
PX161601_Allergy/Sensitivity3_Treatment PX161601030306 Allergy/Sensitivity 3 - Treatment 4 N/A
PX161601_Allergy/Sensitivity3_Type PX161601030301 Allergy/Sensitivity 3 - Type (include medications, foods, environmental, or other) 4 N/A
PX161601_Birth_Apgar_Score PX161601010600 Birth Apgar Score 4 N/A
PX161601_Birth_Doctor PX161601010400 Birth Doctor 4 N/A
PX161601_Birth_Hospital PX161601010100 Birth Hospital 4 N/A
PX161601_Birth_Length PX161601010300 Birth Length 4 N/A
PX161601_Birth_Length_Units PX161601010301 Birth Length - Specify units 4 N/A
PX161601_Birth_Prenatal_Problem PX161601010500 Birth Prenatal Problem 4 N/A
PX161601_Birth_Weight PX161601010200 Birth Weight 4 N/A
PX161601_Birth_Weight_Units PX161601010201 Birth Weight - Specify Units 4 N/A
PX161601_Chicken_Pox_Age PX161601040101 Chicken Pox - Age 4 N/A
PX161601_Chicken_Pox_Date_Day PX161601040103 Chicken Pox - Date - Day 4 N/A
PX161601_Chicken_Pox_Date_Month PX161601040102 Chicken Pox - Date - Month 4 N/A
PX161601_Chicken_Pox_Date_Year PX161601040104 Chicken Pox - Date - Year 4 N/A
PX161601_Chicken_Pox_Remarks PX161601040105 Chicken Pox - Remarks 4 N/A
PX161601_Diphtheria_Booster1_Age PX161601050100 Diphtheria Booster 1 Age 4 N/A
PX161601_Diphtheria_Booster1_Date_Day PX161601050202 Diphtheria Booster 1 Date - Day 4 N/A
PX161601_Diphtheria_Booster1_Date_Month PX161601050201 Diphtheria Booster 1 Date - Month 4 N/A
PX161601_Diphtheria_Booster1_Date_Year PX161601050203 Diphtheria Booster 1 Date - Year 4 N/A
PX161601_Diphtheria_Booster2_Age PX161601050300 Diphtheria Booster 2 Age 4 N/A
PX161601_Diphtheria_Booster2_Date_Day PX161601050402 Diphtheria Booster 2 Date - Day 4 N/A
PX161601_Diphtheria_Booster2_Date_Month PX161601050401 Diphtheria Booster 2 Date - Month 4 N/A
PX161601_Diphtheria_Booster2_Date_Year PX161601050403 Diphtheria Booster 2 Date - Year 4 N/A
PX161601_Diphtheria_Booster3_Age PX161601050500 Diphtheria Booster 3 Age 4 N/A
PX161601_Diphtheria_Booster3_Date_Day PX161601050602 Diphtheria Booster 3 Date - Day 4 N/A
PX161601_Diphtheria_Booster3_Date_Month PX161601050601 Diphtheria Booster 3 Date - Month 4 N/A
PX161601_Diphtheria_Booster3_Date_Year PX161601050603 Diphtheria Booster 3 Date - Year 4 N/A
PX161601_Health_Problem1_Date_Day PX161601020103 Health Problem 1 - Date - Day 4 N/A
PX161601_Health_Problem1_Date_Month PX161601020102 Health Problem 1 - Date - Month 4 N/A
PX161601_Health_Problem1_Date_Year PX161601020104 Health Problem 1 - Date - Year 4 N/A
PX161601_Health_Problem1_Remarks PX161601020105 Health Problem 1 - Remarks (e.g., medications, special tests, x-rays, length of hospital stay, surgery) 4 N/A
PX161601_Health_Problem1_Type PX161601020101 Health Problem 1 - Type 4 N/A
PX161601_Health_Problem2_Date_Day PX161601020203 Health Problem 2 - Date - Day 4 N/A
PX161601_Health_Problem2_Date_Month PX161601020202 Health Problem 2 - Date - Month 4 N/A
PX161601_Health_Problem2_Date_Year PX161601020204 Health Problem 2 - Date - Year 4 N/A
PX161601_Health_Problem2_Remarks PX161601020205 Health Problem 2 - Remarks (e.g., medications, special tests, x-rays, length of hospital stay, surgery) 4 N/A
PX161601_Health_Problem2_Type PX161601020201 Health Problem 2 - Type 4 N/A
PX161601_Health_Problem3_Date_Day PX161601020303 Health Problem 3 - Date - Day 4 N/A
PX161601_Health_Problem3_Date_Month PX161601020302 Health Problem 3 - Date - Month 4 N/A
PX161601_Health_Problem3_Date_Year PX161601020304 Health Problem 3 - Date - Year 4 N/A
PX161601_Health_Problem3_Remarks PX161601020305 Health Problem 3 - Remarks (e.g., medications, special tests, x-rays, length of hospital stay, surgery) 4 N/A
PX161601_Health_Problem3_Type PX161601020301 Health Problem 3 - Type 4 N/A
PX161601_Hepatitis_Age PX161601040401 Hepatitis - Age 4 N/A
PX161601_Hepatitis_B_Booster1_Age PX161601140100 Hepatitis B Booster 1 Age 4 N/A
PX161601_Hepatitis_B_Booster1_Date_Day PX161601140202 Hepatitis B Booster 1 Date - Day 4 N/A
PX161601_Hepatitis_B_Booster1_Date_Month PX161601140201 Hepatitis B Booster 1 Date - Month 4 N/A
PX161601_Hepatitis_B_Booster1_Date_Year PX161601140203 Hepatitis B Booster 1 Date - Year 4 N/A
PX161601_Hepatitis_B_Booster2_Age PX161601140300 Hepatitis B Booster 2 Age 4 N/A
PX161601_Hepatitis_B_Booster2_Date_Day PX161601140402 Hepatitis B Booster 2 Date - Day 4 N/A
PX161601_Hepatitis_B_Booster2_Date_Month PX161601140401 Hepatitis B Booster 2 Date - Month 4 N/A
PX161601_Hepatitis_B_Booster2_Date_Year PX161601140403 Hepatitis B Booster 2 Date - Year 4 N/A
PX161601_Hepatitis_B_Booster3_Age PX161601140500 Hepatitis B Booster 3 Age 4 N/A
PX161601_Hepatitis_B_Booster3_Date_Day PX161601140602 Hepatitis B Booster 3 Date - Day 4 N/A
PX161601_Hepatitis_B_Booster3_Date_Month PX161601140601 Hepatitis B Booster 3 Date - Month 4 N/A
PX161601_Hepatitis_B_Booster3_Date_Year PX161601140603 Hepatitis B Booster 3 Date - Year 4 N/A
PX161601_Hepatitis_Date_Day PX161601040403 Hepatitis - Date - Day 4 N/A
PX161601_Hepatitis_Date_Month PX161601040402 Hepatitis - Date - Month 4 N/A
PX161601_Hepatitis_Date_Year PX161601040404 Hepatitis - Date - Year 4 N/A
PX161601_Hepatitis_Remarks PX161601040405 Hepatitis - Remarks 4 N/A
PX161601_Measles_Age PX161601040201 Measles - Age 4 N/A
PX161601_Measles_Booster1_Age PX161601120100 Measles Booster 1 Age 4 N/A
PX161601_Measles_Booster1_Date_Day PX161601120202 Measles Booster 1 Date - Day 4 N/A
PX161601_Measles_Booster1_Date_Month PX161601120201 Measles Booster 1 Date - Month 4 N/A
PX161601_Measles_Booster1_Date_Year PX161601120203 Measles Booster 1 Date - Year 4 N/A
PX161601_Measles_Booster2_Age PX161601120300 Measles Booster 2 Age 4 N/A
PX161601_Measles_Booster2_Date_Day PX161601120402 Measles Booster 2 Date - Day 4 N/A
PX161601_Measles_Booster2_Date_Month PX161601120401 Measles Booster 2 Date - Month 4 N/A
PX161601_Measles_Booster2_Date_Year PX161601120403 Measles Booster 2 Date - Year 4 N/A
PX161601_Measles_Booster3_Age PX161601120500 Measles Booster 3 Age 4 N/A
PX161601_Measles_Booster3_Date_Day PX161601120602 Measles Booster 3 Date - Day 4 N/A
PX161601_Measles_Booster3_Date_Month PX161601120601 Measles Booster 3 Date - Month 4 N/A
PX161601_Measles_Booster3_Date_Year PX161601120603 Measles Booster 3 Date - Year 4 N/A
PX161601_Measles_Date_Day PX161601040203 Measles - Date - Day 4 N/A
PX161601_Measles_Date_Month PX161601040202 Measles - Date - Month 4 N/A
PX161601_Measles_Date_Year PX161601040204 Measles - Date - Year 4 N/A
PX161601_Measles_Remarks PX161601040205 Measles - Remarks 4 N/A
PX161601_Mumps_Age PX161601040801 Mumps - Age 4 N/A
PX161601_Mumps_Booster1_Age PX161601110100 Mumps Booster 1 Age 4 N/A
PX161601_Mumps_Booster1_Date_Day PX161601110202 Mumps Booster 1 Date - Day 4 N/A
PX161601_Mumps_Booster1_Date_Month PX161601110201 Mumps Booster 1 Date - Month 4 N/A
PX161601_Mumps_Booster1_Date_Year PX161601110203 Mumps Booster 1 Date - Year 4 N/A
PX161601_Mumps_Booster2_Age PX161601110300 Mumps Booster 2 Age 4 N/A
PX161601_Mumps_Booster2_Date_Day PX161601110402 Mumps Booster 2 Date - Day 4 N/A
PX161601_Mumps_Booster2_Date_Month PX161601110401 Mumps Booster 2 Date - Month 4 N/A
PX161601_Mumps_Booster2_Date_Year PX161601110403 Mumps Booster 2 Date - Year 4 N/A
PX161601_Mumps_Booster3_Age PX161601110500 Mumps Booster 3 Age 4 N/A
PX161601_Mumps_Booster3_Date_Day PX161601110602 Mumps Booster 3 Date - Day 4 N/A
PX161601_Mumps_Booster3_Date_Month PX161601110601 Mumps Booster 3 Date - Month 4 N/A
PX161601_Mumps_Booster3_Date_Year PX161601110603 Mumps Booster 3 Date - Year 4 N/A
PX161601_Mumps_Date_Day PX161601040803 Mumps - Date - Day 4 N/A
PX161601_Mumps_Date_Month PX161601040802 Mumps - Date - Month 4 N/A
PX161601_Mumps_Date_Year PX161601040804 Mumps - Date - Year 4 N/A
PX161601_Mumps_Remarks PX161601040805 Mumps - Remarks 4 N/A
PX161601_Other_Age PX161601041001 Other - Age 4 N/A
PX161601_Other_Booster1_Age PX161601150100 Other Booster 1 Age 4 N/A
PX161601_Other_Booster1_Date_Day PX161601150202 Other Booster 1 Date - Day 4 N/A
PX161601_Other_Booster1_Date_Month PX161601150201 Other Booster 1 Date - Month 4 N/A
PX161601_Other_Booster1_Date_Year PX161601150203 Other Booster 1 Date - Year 4 N/A
PX161601_Other_Booster2_Age PX161601150300 Other Booster 2 Age 4 N/A
PX161601_Other_Booster2_Date_Day PX161601150402 Other Booster 2 Date - Day 4 N/A
PX161601_Other_Booster2_Date_Month PX161601150401 Other Booster 2 Date - Month 4 N/A
PX161601_Other_Booster2_Date_Year PX161601150403 Other Booster 2 Date - Year 4 N/A
PX161601_Other_Booster3_Age PX161601150500 Other Booster 3 Age 4 N/A
PX161601_Other_Booster3_Date_Day PX161601150602 Other Booster 3 Date - Day 4 N/A
PX161601_Other_Booster3_Date_Month PX161601150601 Other Booster 3 Date - Month 4 N/A
PX161601_Other_Date_Day PX161601041003 Other - Date - Day 4 N/A
PX161601_Other_Date_Month PX161601041002 Other - Date - Month 4 N/A
PX161601_Other_Date_Year PX161601041004 Other - Date - Year 4 N/A
PX161601_Other_Remarks PX161601041005 Other - Remarks 4 N/A
PX161601_Pertussis/Whooping_Cough_Age PX161601040501 Pertussis/Whooping Cough - Age 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster1_Age PX161601060100 Pertussis/Whooping Cough Booster 1 Age 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster1_Date_Day PX161601060202 Pertussis/Whooping Cough Booster 1 Date - Day 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster1_Date_Month PX161601060201 Pertussis/Whooping Cough Booster 1 Date - Month 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster1_Date_Year PX161601060203 Pertussis/Whooping Cough Booster 1 Date - Year 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster2_Age PX161601060300 Pertussis/Whooping Cough Booster 2 Age 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster2_Date_Day PX161601060402 Pertussis/Whooping Cough Booster 2 Date - Day 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster2_Date_Month PX161601060401 Pertussis/Whooping Cough Booster 2 Date - Month 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster2_Date_Year PX161601060403 Pertussis/Whooping Cough Booster 2 Date - Year 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster3_Age PX161601060500 Pertussis/Whooping Cough Booster 3 Age 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster3_Date_Day PX161601060602 Pertussis/Whooping Cough Booster 3 Date - Day 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster3_Date_Month PX161601060601 Pertussis/Whooping Cough Booster 3 Date - Month 4 N/A
PX161601_Pertussis/Whooping_Cough_Booster3_Date_Year PX161601060603 Pertussis/Whooping Cough Booster 3 Date - Year 4 N/A
PX161601_Pertussis/Whooping_Cough_Date_Day PX161601040503 Pertussis/Whooping Cough - Date - Day 4 N/A
PX161601_Pertussis/Whooping_Cough_Date_Month PX161601040502 Pertussis/Whooping Cough - Date - Month 4 N/A
PX161601_Pertussis/Whooping_Cough_Date_Year PX161601040504 Pertussis/Whooping Cough - Date - Year 4 N/A
PX161601_Pertussis/Whooping_Cough_Remarks PX161601040505 Pertussis/Whooping Cough - Remarks 4 N/A
PX161601_Pneumonia_Age PX161601040601 Pneumonia - Age 4 N/A
PX161601_Pneumonia_Date_Day PX161601040603 Pneumonia - Date - Day 4 N/A
PX161601_Pneumonia_Date_Month PX161601040602 Pneumonia - Date - Month 4 N/A
PX161601_Pneumonia_Date_Year PX161601040604 Pneumonia - Date - Year 4 N/A
PX161601_Pneumonia_Remarks PX161601040605 Pneumonia - Remarks 4 N/A
PX161601_Polio_Age PX161601040701 Polio - Age 4 N/A
PX161601_Polio_Date_Day PX161601040703 Polio - Date - Day 4 N/A
PX161601_Polio_Date_Month PX161601040702 Polio - Date - Month 4 N/A
PX161601_Polio_Date_Year PX161601040704 Polio - Date - Year 4 N/A
PX161601_Polio_Remarks PX161601040705 Polio - Remarks 4 N/A
PX161601_Rubella_Age PX161601040301 Rubella - Age 4 N/A
PX161601_Rubella_Booster1_Age PX161601100100 Rubella Booster 1 Age 4 N/A
PX161601_Rubella_Booster1_Date_Day PX161601100202 Rubella Booster 1 Date - Day 4 N/A
PX161601_Rubella_Booster1_Date_Month PX161601100201 Rubella Booster 1 Date - Month 4 N/A
PX161601_Rubella_Booster1_Date_Year PX161601100203 Rubella Booster 1 Date - Year 4 N/A
PX161601_Rubella_Booster2_Age PX161601100300 Rubella Booster 2 Age 4 N/A
PX161601_Rubella_Booster2_Date_Day PX161601100402 Rubella Booster 2 Date - Day 4 N/A
PX161601_Rubella_Booster2_Date_Month PX161601100401 Rubella Booster 2 Date - Month 4 N/A
PX161601_Rubella_Booster2_Date_Year PX161601100403 Rubella Booster 2 Date - Year 4 N/A
PX161601_Rubella_Booster3_Age PX161601100500 Rubella Booster 3 Age 4 N/A
PX161601_Rubella_Booster3_Date_Day PX161601100602 Rubella Booster 3 Date - Day 4 N/A
PX161601_Rubella_Booster3_Date_Month PX161601100601 Rubella Booster 3 Date - Month 4 N/A
PX161601_Rubella_Booster3_Date_Year PX161601100603 Rubella Booster 3 Date - Year 4 N/A
PX161601_Rubella_Date_Day PX161601040303 Rubella - Date - Day 4 N/A
PX161601_Rubella_Date_Month PX161601040302 Rubella - Date - Month 4 N/A
PX161601_Rubella_Date_Year PX161601040304 Rubella - Date - Year 4 N/A
PX161601_Rubella_Remarks PX161601040305 Rubella - Remarks 4 N/A
PX161601_Scarlet_Fever_Age PX161601040901 Scarlet Fever - Age 4 N/A
PX161601_Scarlet_Fever_Date_Day PX161601040903 Scarlet Fever - Date - Day 4 N/A
PX161601_Scarlet_Fever_Date_Month PX161601040902 Scarlet Fever - Date - Month 4 N/A
PX161601_Scarlet_Fever_Date_Year PX161601040904 Scarlet Fever - Date - Year 4 N/A
PX161601_Scarlet_Fever_Remarks PX161601040905 Scarlet Fever - Remarks 4 N/A
PX161601_Smallpox_Booster1_Age PX161601080100 Smallpox Booster 1 Age 4 N/A
PX161601_Smallpox_Booster1_Date_Day PX161601080202 Smallpox Booster 1 Date - Day 4 N/A
PX161601_Smallpox_Booster1_Date_Month PX161601080201 Smallpox Booster 1 Date - Month 4 N/A
PX161601_Smallpox_Booster1_Date_Year PX161601080203 Smallpox Booster 1 Date - Year 4 N/A
PX161601_Smallpox_Booster2_Age PX161601080300 Smallpox Booster 2 Age 4 N/A
PX161601_Smallpox_Booster2_Date_Day PX161601080402 Smallpox Booster 2 Date - Day 4 N/A
PX161601_Smallpox_Booster2_Date_Month PX161601080401 Smallpox Booster 2 Date - Month 4 N/A
PX161601_Smallpox_Booster2_Date_Year PX161601080403 Smallpox Booster 2 Date - Year 4 N/A
PX161601_Smallpox_Booster3_Age PX161601080500 Smallpox Booster 3 Age 4 N/A
PX161601_Smallpox_Booster3_Date_Day PX161601080602 Smallpox Booster 3 Date - Day 4 N/A
PX161601_Smallpox_Booster3_Date_Month PX161601080601 Smallpox Booster 3 Date - Month 4 N/A
PX161601_Smallpox_Booster3_Date_Year PX161601080603 Smallpox Booster 3 Date - Year 4 N/A
PX161601_Tetanus_Booster1_Age PX161601070100 Tetanus Booster 1 Age 4 N/A
PX161601_Tetanus_Booster1_Date_Day PX161601070202 Tetanus Booster 1 Date - Day 4 N/A
PX161601_Tetanus_Booster1_Date_Month PX161601070201 Tetanus Booster 1 Date - Month 4 N/A
PX161601_Tetanus_Booster1_Date_Year PX161601070203 Tetanus Booster 1 Date - Year 4 N/A
PX161601_Tetanus_Booster2_Age PX161601070300 Tetanus Booster 2 Age 4 N/A
PX161601_Tetanus_Booster2_Date_Day PX161601070402 Tetanus Booster 2 Date - Day 4 N/A
PX161601_Tetanus_Booster2_Date_Month PX161601070401 Tetanus Booster 2 Date - Month 4 N/A
PX161601_Tetanus_Booster2_Date_Year PX161601070403 Tetanus Booster 2 Date - Year 4 N/A
PX161601_Tetanus_Booster3_Age PX161601070500 Tetanus Booster 3 Age 4 N/A
PX161601_Tetanus_Booster3_Date_Day PX161601070602 Tetanus Booster 3 Date - Day 4 N/A
PX161601_Tetanus_Booster3_Date_Month PX161601070601 Tetanus Booster 3 Date - Month 4 N/A
PX161601_Tetanus_Booster3_Date_Year PX161601070603 Tetanus Booster 3 Date - Year 4 N/A
PX161601_Tuberculosis_Booster1_Age PX161601130100 Tuberculosis Booster 1 Age 4 N/A
PX161601_Tuberculosis_Booster1_Date_Day PX161601130202 Tuberculosis Booster 1 Date - Day 4 N/A
PX161601_Tuberculosis_Booster1_Date_Month PX161601130201 Tuberculosis Booster 1 Date - Month 4 N/A
PX161601_Tuberculosis_Booster1_Date_Year PX161601130203 Tuberculosis Booster 1 Date - Year 4 N/A
PX161601_Tuberculosis_Booster2_Age PX161601130300 Tuberculosis Booster 2 Age 4 N/A
PX161601_Tuberculosis_Booster2_Date_Day PX161601130402 Tuberculosis Booster 2 Date - Day 4 N/A
PX161601_Tuberculosis_Booster2_Date_Month PX161601130401 Tuberculosis Booster 2 Date - Month 4 N/A
PX161601_Tuberculosis_Booster2_Date_Year PX161601130403 Tuberculosis Booster 2 Date - Year 4 N/A
PX161601_Tuberculosis_Booster3_Age PX161601130500 Tuberculosis Booster 3 Age 4 N/A
PX161601_Tuberculosis_Booster3_Date_Day PX161601130602 Tuberculosis Booster 3 Date - Day 4 N/A
PX161601_Tuberculosis_Booster3_Date_Month PX161601130601 Tuberculosis Booster 3 Date - Month 4 N/A
PX161601_Tuberculosis_Booster3_Date_Year PX161601130603 Tuberculosis Booster 3 Date - Year 4 N/A
PX161601_Typhoid_Booster1_Age PX161601090100 Typhoid Booster 1 Age 4 N/A
PX161601_Typhoid_Booster1_Date_Day PX161601090202 Typhoid Booster 1 Date - Day 4 N/A
PX161601_Typhoid_Booster1_Date_Month PX161601090201 Typhoid Booster 1 Date - Month 4 N/A
PX161601_Typhoid_Booster1_Date_Year PX161601090203 Typhoid Booster 1 Date - Year 4 N/A
PX161601_Typhoid_Booster2_Age PX161601090300 Typhoid Booster 2 Age 4 N/A
PX161601_Typhoid_Booster2_Date_Day PX161601090402 Typhoid Booster 2 Date - Day 4 N/A
PX161601_Typhoid_Booster2_Date_Month PX161601090401 Typhoid Booster 2 Date - Month 4 N/A
PX161601_Typhoid_Booster2_Date_Year PX161601090403 Typhoid Booster 2 Date - Year 4 N/A
PX161601_Typhoid_Booster3_Age PX161601090500 Typhoid Booster 3 Age 4 N/A
PX161601_Typhoid_Booster3_Date_Day PX161601090602 Typhoid Booster 3 Date - Day 4 N/A
PX161601_Typhoid_Booster3_Date_Month PX161601090601 Typhoid Booster 3 Date - Month 4 N/A
PX161601_Typhoid_Booster3_Date_Year PX161601090603 Typhoid Booster 3 Date - Year 4 N/A
PX161601__Other_Booster3_Date_Year PX161601150603 Other Booster 3 Date -Year 4 N/A
Research Domain Information
Measure Name:

Personal Medical History of Allergies, Infectious Diseases, and Immunizations

Release Date:

November 12, 2010

Definition

This measure is a questionnaire to collect information on a participant's personal medical history of allergies, infectious diseases, and immunizations.

Purpose

This measure can be used to establish a respondent's medical history of allergies, selected infectious diseases, and immunizations.

Keywords

Infectious disease, Immunizations, Allergies, Personal history, Medical history, American Health Information Management Association, AHIMA, My Personal Health Record, MyPHR, Infectious Diseases and Immunity