Protocol - Personal Medical History of Allergies, Infectious Diseases, and Immunizations - Child
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.
Specific Instructions:
None
Protocol:
A. Birth
| Hospital |
| Height |
| Length |
| Doctor |
| Prenatal Problem |
| Apgar Score |
B. Health Log
| Date | Health Problem | Remarks |
| | | |
| | | |
| | | |
C. Allergies/Drug Sensitivities
| Allergy/Sensitivity Type | 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:
Availability:
Personnel and Training Required
None
Equipment Needs
None
Requirements
| Requirement Category | Required |
|---|---|
| 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.
Selection Rationale
The American Health Information Management Associations (AHIMAs) 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
| Standard | Name | ID | Source |
|---|---|---|---|
| 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 |
| Human Phenotype Ontology | Allergy | HP:0012393 | HPO |
Derived Variables
None
Process and Review
Not applicable.
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 Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX161601_Allergy/Sensitivity1_Date_Last_Occurred_Day | ||||
| PX161601030104 | Allergy/Sensitivity 1 - Date Last Occurred - Day | N/A | ||
| PX161601_Allergy/Sensitivity1_Date_Last_Occurred_Month | ||||
| PX161601030103 | Allergy/Sensitivity 1 - Date Last Occurred - Month | N/A | ||
| PX161601_Allergy/Sensitivity1_Date_Last_Occurred_Year | ||||
| PX161601030105 | Allergy/Sensitivity 1 - Date Last Occurred - Year | N/A | ||
| PX161601_Allergy/Sensitivity1_Reaction | ||||
| PX161601030102 | Allergy/Sensitivity 1 - Reaction | N/A | ||
| PX161601_Allergy/Sensitivity1_Treatment | ||||
| PX161601030106 | Allergy/Sensitivity 1 - Treatment | N/A | ||
| PX161601_Allergy/Sensitivity1_Type | ||||
| PX161601030101 | Allergy/Sensitivity 1 - Type (include more | N/A | ||
| PX161601_Allergy/Sensitivity2_Date_Last_Occurred_Day | ||||
| PX161601030204 | Allergy/Sensitivity 2 - Date Last Occurred - Day | N/A | ||
| PX161601_Allergy/Sensitivity2_Date_Last_Occurred_Month | ||||
| PX161601030203 | Allergy/Sensitivity 2 - Date Last Occurred - Month | N/A | ||
| PX161601_Allergy/Sensitivity2_Date_Last_Occurred_Year | ||||
| PX161601030205 | Allergy/Sensitivity 2 - Date Last Occurred - Year | N/A | ||
| PX161601_Allergy/Sensitivity2_Reaction | ||||
| PX161601030202 | Allergy/Sensitivity 2 - Reaction | N/A | ||
| PX161601_Allergy/Sensitivity2_Treatment | ||||
| PX161601030206 | Allergy/Sensitivity 2 - Treatment | N/A | ||
| PX161601_Allergy/Sensitivity2_Type | ||||
| PX161601030201 | Allergy/Sensitivity 2 - Type (include more | N/A | ||
| PX161601_Allergy/Sensitivity3_Date_Last_Occurred_Day | ||||
| PX161601030304 | Allergy/Sensitivity 3 - Date Last Occurred - Day | N/A | ||
| PX161601_Allergy/Sensitivity3_Date_Last_Occurred_Month | ||||
| PX161601030303 | Allergy/Sensitivity 3 - Date Last Occurred - Month | N/A | ||
| PX161601_Allergy/Sensitivity3_Date_Last_Occurred_Year | ||||
| PX161601030305 | Allergy/Sensitivity 3 - Date Last Occurred - Year | N/A | ||
| PX161601_Allergy/Sensitivity3_Reaction | ||||
| PX161601030302 | Allergy/Sensitivity 3 - Reaction | N/A | ||
| PX161601_Allergy/Sensitivity3_Treatment | ||||
| PX161601030306 | Allergy/Sensitivity 3 - Treatment | N/A | ||
| PX161601_Allergy/Sensitivity3_Type | ||||
| PX161601030301 | Allergy/Sensitivity 3 - Type (include more | N/A | ||
| PX161601_Birth_Apgar_Score | ||||
| PX161601010600 | Birth Apgar Score | N/A | ||
| PX161601_Birth_Doctor | ||||
| PX161601010400 | Birth Doctor | N/A | ||
| PX161601_Birth_Hospital | ||||
| PX161601010100 | Birth Hospital | N/A | ||
| PX161601_Birth_Length | ||||
| PX161601010300 | Birth Length | Variable Mapping | ||
| PX161601_Birth_Length_Units | ||||
| PX161601010301 | Birth Length - Specify units | N/A | ||
| PX161601_Birth_Prenatal_Problem | ||||
| PX161601010500 | Birth Prenatal Problem | N/A | ||
| PX161601_Birth_Weight | ||||
| PX161601010200 | Birth Weight | Variable Mapping | ||
| PX161601_Birth_Weight_Units | ||||
| PX161601010201 | Birth Weight - Specify Units | Variable Mapping | ||
| PX161601_Chicken_Pox_Age | ||||
| PX161601040101 | Chicken Pox - Age | N/A | ||
| PX161601_Chicken_Pox_Date_Day | ||||
| PX161601040103 | Chicken Pox - Date - Day | N/A | ||
| PX161601_Chicken_Pox_Date_Month | ||||
| PX161601040102 | Chicken Pox - Date - Month | N/A | ||
| PX161601_Chicken_Pox_Date_Year | ||||
| PX161601040104 | Chicken Pox - Date - Year | N/A | ||
| PX161601_Chicken_Pox_Remarks | ||||
| PX161601040105 | Chicken Pox - Remarks | N/A | ||
| PX161601_Diphtheria_Booster1_Age | ||||
| PX161601050100 | Diphtheria Booster 1 Age | N/A | ||
| PX161601_Diphtheria_Booster1_Date_Day | ||||
| PX161601050202 | Diphtheria Booster 1 Date - Day | N/A | ||
| PX161601_Diphtheria_Booster1_Date_Month | ||||
| PX161601050201 | Diphtheria Booster 1 Date - Month | N/A | ||
| PX161601_Diphtheria_Booster1_Date_Year | ||||
| PX161601050203 | Diphtheria Booster 1 Date - Year | N/A | ||
| PX161601_Diphtheria_Booster2_Age | ||||
| PX161601050300 | Diphtheria Booster 2 Age | N/A | ||
| PX161601_Diphtheria_Booster2_Date_Day | ||||
| PX161601050402 | Diphtheria Booster 2 Date - Day | N/A | ||
| PX161601_Diphtheria_Booster2_Date_Month | ||||
| PX161601050401 | Diphtheria Booster 2 Date - Month | N/A | ||
| PX161601_Diphtheria_Booster2_Date_Year | ||||
| PX161601050403 | Diphtheria Booster 2 Date - Year | N/A | ||
| PX161601_Diphtheria_Booster3_Age | ||||
| PX161601050500 | Diphtheria Booster 3 Age | N/A | ||
| PX161601_Diphtheria_Booster3_Date_Day | ||||
| PX161601050602 | Diphtheria Booster 3 Date - Day | N/A | ||
| PX161601_Diphtheria_Booster3_Date_Month | ||||
| PX161601050601 | Diphtheria Booster 3 Date - Month | N/A | ||
| PX161601_Diphtheria_Booster3_Date_Year | ||||
| PX161601050603 | Diphtheria Booster 3 Date - Year | N/A | ||
| PX161601_Health_Problem1_Date_Day | ||||
| PX161601020103 | Health Problem 1 - Date - Day | N/A | ||
| PX161601_Health_Problem1_Date_Month | ||||
| PX161601020102 | Health Problem 1 - Date - Month | N/A | ||
| PX161601_Health_Problem1_Date_Year | ||||
| PX161601020104 | Health Problem 1 - Date - Year | N/A | ||
| PX161601_Health_Problem1_Remarks | ||||
| PX161601020105 | Health Problem 1 - Remarks (e.g., more | N/A | ||
| PX161601_Health_Problem1_Type | ||||
| PX161601020101 | Health Problem 1 - Type | N/A | ||
| PX161601_Health_Problem2_Date_Day | ||||
| PX161601020203 | Health Problem 2 - Date - Day | N/A | ||
| PX161601_Health_Problem2_Date_Month | ||||
| PX161601020202 | Health Problem 2 - Date - Month | N/A | ||
| PX161601_Health_Problem2_Date_Year | ||||
| PX161601020204 | Health Problem 2 - Date - Year | N/A | ||
| PX161601_Health_Problem2_Remarks | ||||
| PX161601020205 | Health Problem 2 - Remarks (e.g., more | N/A | ||
| PX161601_Health_Problem2_Type | ||||
| PX161601020201 | Health Problem 2 - Type | N/A | ||
| PX161601_Health_Problem3_Date_Day | ||||
| PX161601020303 | Health Problem 3 - Date - Day | N/A | ||
| PX161601_Health_Problem3_Date_Month | ||||
| PX161601020302 | Health Problem 3 - Date - Month | N/A | ||
| PX161601_Health_Problem3_Date_Year | ||||
| PX161601020304 | Health Problem 3 - Date - Year | N/A | ||
| PX161601_Health_Problem3_Remarks | ||||
| PX161601020305 | Health Problem 3 - Remarks (e.g., more | N/A | ||
| PX161601_Health_Problem3_Type | ||||
| PX161601020301 | Health Problem 3 - Type | N/A | ||
| PX161601_Hepatitis_Age | ||||
| PX161601040401 | Hepatitis - Age | N/A | ||
| PX161601_Hepatitis_B_Booster1_Age | ||||
| PX161601140100 | Hepatitis B Booster 1 Age | N/A | ||
| PX161601_Hepatitis_B_Booster1_Date_Day | ||||
| PX161601140202 | Hepatitis B Booster 1 Date - Day | N/A | ||
| PX161601_Hepatitis_B_Booster1_Date_Month | ||||
| PX161601140201 | Hepatitis B Booster 1 Date - Month | N/A | ||
| PX161601_Hepatitis_B_Booster1_Date_Year | ||||
| PX161601140203 | Hepatitis B Booster 1 Date - Year | N/A | ||
| PX161601_Hepatitis_B_Booster2_Age | ||||
| PX161601140300 | Hepatitis B Booster 2 Age | N/A | ||
| PX161601_Hepatitis_B_Booster2_Date_Day | ||||
| PX161601140402 | Hepatitis B Booster 2 Date - Day | N/A | ||
| PX161601_Hepatitis_B_Booster2_Date_Month | ||||
| PX161601140401 | Hepatitis B Booster 2 Date - Month | N/A | ||
| PX161601_Hepatitis_B_Booster2_Date_Year | ||||
| PX161601140403 | Hepatitis B Booster 2 Date - Year | N/A | ||
| PX161601_Hepatitis_B_Booster3_Age | ||||
| PX161601140500 | Hepatitis B Booster 3 Age | N/A | ||
| PX161601_Hepatitis_B_Booster3_Date_Day | ||||
| PX161601140602 | Hepatitis B Booster 3 Date - Day | N/A | ||
| PX161601_Hepatitis_B_Booster3_Date_Month | ||||
| PX161601140601 | Hepatitis B Booster 3 Date - Month | N/A | ||
| PX161601_Hepatitis_B_Booster3_Date_Year | ||||
| PX161601140603 | Hepatitis B Booster 3 Date - Year | N/A | ||
| PX161601_Hepatitis_Date_Day | ||||
| PX161601040403 | Hepatitis - Date - Day | N/A | ||
| PX161601_Hepatitis_Date_Month | ||||
| PX161601040402 | Hepatitis - Date - Month | N/A | ||
| PX161601_Hepatitis_Date_Year | ||||
| PX161601040404 | Hepatitis - Date - Year | N/A | ||
| PX161601_Hepatitis_Remarks | ||||
| PX161601040405 | Hepatitis - Remarks | N/A | ||
| PX161601_Measles_Age | ||||
| PX161601040201 | Measles - Age | N/A | ||
| PX161601_Measles_Booster1_Age | ||||
| PX161601120100 | Measles Booster 1 Age | N/A | ||
| PX161601_Measles_Booster1_Date_Day | ||||
| PX161601120202 | Measles Booster 1 Date - Day | N/A | ||
| PX161601_Measles_Booster1_Date_Month | ||||
| PX161601120201 | Measles Booster 1 Date - Month | N/A | ||
| PX161601_Measles_Booster1_Date_Year | ||||
| PX161601120203 | Measles Booster 1 Date - Year | N/A | ||
| PX161601_Measles_Booster2_Age | ||||
| PX161601120300 | Measles Booster 2 Age | N/A | ||
| PX161601_Measles_Booster2_Date_Day | ||||
| PX161601120402 | Measles Booster 2 Date - Day | N/A | ||
| PX161601_Measles_Booster2_Date_Month | ||||
| PX161601120401 | Measles Booster 2 Date - Month | N/A | ||
| PX161601_Measles_Booster2_Date_Year | ||||
| PX161601120403 | Measles Booster 2 Date - Year | N/A | ||
| PX161601_Measles_Booster3_Age | ||||
| PX161601120500 | Measles Booster 3 Age | N/A | ||
| PX161601_Measles_Booster3_Date_Day | ||||
| PX161601120602 | Measles Booster 3 Date - Day | N/A | ||
| PX161601_Measles_Booster3_Date_Month | ||||
| PX161601120601 | Measles Booster 3 Date - Month | N/A | ||
| PX161601_Measles_Booster3_Date_Year | ||||
| PX161601120603 | Measles Booster 3 Date - Year | N/A | ||
| PX161601_Measles_Date_Day | ||||
| PX161601040203 | Measles - Date - Day | N/A | ||
| PX161601_Measles_Date_Month | ||||
| PX161601040202 | Measles - Date - Month | N/A | ||
| PX161601_Measles_Date_Year | ||||
| PX161601040204 | Measles - Date - Year | N/A | ||
| PX161601_Measles_Remarks | ||||
| PX161601040205 | Measles - Remarks | N/A | ||
| PX161601_Mumps_Age | ||||
| PX161601040801 | Mumps - Age | N/A | ||
| PX161601_Mumps_Booster1_Age | ||||
| PX161601110100 | Mumps Booster 1 Age | N/A | ||
| PX161601_Mumps_Booster1_Date_Day | ||||
| PX161601110202 | Mumps Booster 1 Date - Day | N/A | ||
| PX161601_Mumps_Booster1_Date_Month | ||||
| PX161601110201 | Mumps Booster 1 Date - Month | N/A | ||
| PX161601_Mumps_Booster1_Date_Year | ||||
| PX161601110203 | Mumps Booster 1 Date - Year | N/A | ||
| PX161601_Mumps_Booster2_Age | ||||
| PX161601110300 | Mumps Booster 2 Age | N/A | ||
| PX161601_Mumps_Booster2_Date_Day | ||||
| PX161601110402 | Mumps Booster 2 Date - Day | N/A | ||
| PX161601_Mumps_Booster2_Date_Month | ||||
| PX161601110401 | Mumps Booster 2 Date - Month | N/A | ||
| PX161601_Mumps_Booster2_Date_Year | ||||
| PX161601110403 | Mumps Booster 2 Date - Year | N/A | ||
| PX161601_Mumps_Booster3_Age | ||||
| PX161601110500 | Mumps Booster 3 Age | N/A | ||
| PX161601_Mumps_Booster3_Date_Day | ||||
| PX161601110602 | Mumps Booster 3 Date - Day | N/A | ||
| PX161601_Mumps_Booster3_Date_Month | ||||
| PX161601110601 | Mumps Booster 3 Date - Month | N/A | ||
| PX161601_Mumps_Booster3_Date_Year | ||||
| PX161601110603 | Mumps Booster 3 Date - Year | N/A | ||
| PX161601_Mumps_Date_Day | ||||
| PX161601040803 | Mumps - Date - Day | N/A | ||
| PX161601_Mumps_Date_Month | ||||
| PX161601040802 | Mumps - Date - Month | N/A | ||
| PX161601_Mumps_Date_Year | ||||
| PX161601040804 | Mumps - Date - Year | N/A | ||
| PX161601_Mumps_Remarks | ||||
| PX161601040805 | Mumps - Remarks | N/A | ||
| PX161601_Other_Age | ||||
| PX161601041001 | Other - Age | N/A | ||
| PX161601_Other_Booster1_Age | ||||
| PX161601150100 | Other Booster 1 Age | N/A | ||
| PX161601_Other_Booster1_Date_Day | ||||
| PX161601150202 | Other Booster 1 Date - Day | N/A | ||
| PX161601_Other_Booster1_Date_Month | ||||
| PX161601150201 | Other Booster 1 Date - Month | N/A | ||
| PX161601_Other_Booster1_Date_Year | ||||
| PX161601150203 | Other Booster 1 Date - Year | N/A | ||
| PX161601_Other_Booster2_Age | ||||
| PX161601150300 | Other Booster 2 Age | N/A | ||
| PX161601_Other_Booster2_Date_Day | ||||
| PX161601150402 | Other Booster 2 Date - Day | N/A | ||
| PX161601_Other_Booster2_Date_Month | ||||
| PX161601150401 | Other Booster 2 Date - Month | N/A | ||
| PX161601_Other_Booster2_Date_Year | ||||
| PX161601150403 | Other Booster 2 Date - Year | N/A | ||
| PX161601_Other_Booster3_Age | ||||
| PX161601150500 | Other Booster 3 Age | N/A | ||
| PX161601_Other_Booster3_Date_Day | ||||
| PX161601150602 | Other Booster 3 Date - Day | N/A | ||
| PX161601_Other_Booster3_Date_Month | ||||
| PX161601150601 | Other Booster 3 Date - Month | N/A | ||
| PX161601_Other_Date_Day | ||||
| PX161601041003 | Other - Date - Day | N/A | ||
| PX161601_Other_Date_Month | ||||
| PX161601041002 | Other - Date - Month | N/A | ||
| PX161601_Other_Date_Year | ||||
| PX161601041004 | Other - Date - Year | N/A | ||
| PX161601_Other_Remarks | ||||
| PX161601041005 | Other - Remarks | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Age | ||||
| PX161601040501 | Pertussis/Whooping Cough - Age | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster1_Age | ||||
| PX161601060100 | Pertussis/Whooping Cough Booster 1 Age | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster1_Date_Day | ||||
| PX161601060202 | Pertussis/Whooping Cough Booster 1 Date - Day | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster1_Date_Month | ||||
| PX161601060201 | Pertussis/Whooping Cough Booster 1 Date - Month | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster1_Date_Year | ||||
| PX161601060203 | Pertussis/Whooping Cough Booster 1 Date - Year | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster2_Age | ||||
| PX161601060300 | Pertussis/Whooping Cough Booster 2 Age | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster2_Date_Day | ||||
| PX161601060402 | Pertussis/Whooping Cough Booster 2 Date - Day | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster2_Date_Month | ||||
| PX161601060401 | Pertussis/Whooping Cough Booster 2 Date - Month | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster2_Date_Year | ||||
| PX161601060403 | Pertussis/Whooping Cough Booster 2 Date - Year | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster3_Age | ||||
| PX161601060500 | Pertussis/Whooping Cough Booster 3 Age | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster3_Date_Day | ||||
| PX161601060602 | Pertussis/Whooping Cough Booster 3 Date - Day | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster3_Date_Month | ||||
| PX161601060601 | Pertussis/Whooping Cough Booster 3 Date - Month | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Booster3_Date_Year | ||||
| PX161601060603 | Pertussis/Whooping Cough Booster 3 Date - Year | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Date_Day | ||||
| PX161601040503 | Pertussis/Whooping Cough - Date - Day | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Date_Month | ||||
| PX161601040502 | Pertussis/Whooping Cough - Date - Month | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Date_Year | ||||
| PX161601040504 | Pertussis/Whooping Cough - Date - Year | N/A | ||
| PX161601_Pertussis/Whooping_Cough_Remarks | ||||
| PX161601040505 | Pertussis/Whooping Cough - Remarks | N/A | ||
| PX161601_Pneumonia_Age | ||||
| PX161601040601 | Pneumonia - Age | Variable Mapping | ||
| PX161601_Pneumonia_Date_Day | ||||
| PX161601040603 | Pneumonia - Date - Day | N/A | ||
| PX161601_Pneumonia_Date_Month | ||||
| PX161601040602 | Pneumonia - Date - Month | N/A | ||
| PX161601_Pneumonia_Date_Year | ||||
| PX161601040604 | Pneumonia - Date - Year | N/A | ||
| PX161601_Pneumonia_Remarks | ||||
| PX161601040605 | Pneumonia - Remarks | N/A | ||
| PX161601_Polio_Age | ||||
| PX161601040701 | Polio - Age | N/A | ||
| PX161601_Polio_Date_Day | ||||
| PX161601040703 | Polio - Date - Day | N/A | ||
| PX161601_Polio_Date_Month | ||||
| PX161601040702 | Polio - Date - Month | N/A | ||
| PX161601_Polio_Date_Year | ||||
| PX161601040704 | Polio - Date - Year | N/A | ||
| PX161601_Polio_Remarks | ||||
| PX161601040705 | Polio - Remarks | N/A | ||
| PX161601_Rubella_Age | ||||
| PX161601040301 | Rubella - Age | N/A | ||
| PX161601_Rubella_Booster1_Age | ||||
| PX161601100100 | Rubella Booster 1 Age | N/A | ||
| PX161601_Rubella_Booster1_Date_Day | ||||
| PX161601100202 | Rubella Booster 1 Date - Day | N/A | ||
| PX161601_Rubella_Booster1_Date_Month | ||||
| PX161601100201 | Rubella Booster 1 Date - Month | N/A | ||
| PX161601_Rubella_Booster1_Date_Year | ||||
| PX161601100203 | Rubella Booster 1 Date - Year | N/A | ||
| PX161601_Rubella_Booster2_Age | ||||
| PX161601100300 | Rubella Booster 2 Age | N/A | ||
| PX161601_Rubella_Booster2_Date_Day | ||||
| PX161601100402 | Rubella Booster 2 Date - Day | N/A | ||
| PX161601_Rubella_Booster2_Date_Month | ||||
| PX161601100401 | Rubella Booster 2 Date - Month | N/A | ||
| PX161601_Rubella_Booster2_Date_Year | ||||
| PX161601100403 | Rubella Booster 2 Date - Year | N/A | ||
| PX161601_Rubella_Booster3_Age | ||||
| PX161601100500 | Rubella Booster 3 Age | N/A | ||
| PX161601_Rubella_Booster3_Date_Day | ||||
| PX161601100602 | Rubella Booster 3 Date - Day | N/A | ||
| PX161601_Rubella_Booster3_Date_Month | ||||
| PX161601100601 | Rubella Booster 3 Date - Month | N/A | ||
| PX161601_Rubella_Booster3_Date_Year | ||||
| PX161601100603 | Rubella Booster 3 Date - Year | N/A | ||
| PX161601_Rubella_Date_Day | ||||
| PX161601040303 | Rubella - Date - Day | N/A | ||
| PX161601_Rubella_Date_Month | ||||
| PX161601040302 | Rubella - Date - Month | N/A | ||
| PX161601_Rubella_Date_Year | ||||
| PX161601040304 | Rubella - Date - Year | N/A | ||
| PX161601_Rubella_Remarks | ||||
| PX161601040305 | Rubella - Remarks | N/A | ||
| PX161601_Scarlet_Fever_Age | ||||
| PX161601040901 | Scarlet Fever - Age | N/A | ||
| PX161601_Scarlet_Fever_Date_Day | ||||
| PX161601040903 | Scarlet Fever - Date - Day | N/A | ||
| PX161601_Scarlet_Fever_Date_Month | ||||
| PX161601040902 | Scarlet Fever - Date - Month | N/A | ||
| PX161601_Scarlet_Fever_Date_Year | ||||
| PX161601040904 | Scarlet Fever - Date - Year | N/A | ||
| PX161601_Scarlet_Fever_Remarks | ||||
| PX161601040905 | Scarlet Fever - Remarks | N/A | ||
| PX161601_Smallpox_Booster1_Age | ||||
| PX161601080100 | Smallpox Booster 1 Age | N/A | ||
| PX161601_Smallpox_Booster1_Date_Day | ||||
| PX161601080202 | Smallpox Booster 1 Date - Day | N/A | ||
| PX161601_Smallpox_Booster1_Date_Month | ||||
| PX161601080201 | Smallpox Booster 1 Date - Month | N/A | ||
| PX161601_Smallpox_Booster1_Date_Year | ||||
| PX161601080203 | Smallpox Booster 1 Date - Year | N/A | ||
| PX161601_Smallpox_Booster2_Age | ||||
| PX161601080300 | Smallpox Booster 2 Age | N/A | ||
| PX161601_Smallpox_Booster2_Date_Day | ||||
| PX161601080402 | Smallpox Booster 2 Date - Day | N/A | ||
| PX161601_Smallpox_Booster2_Date_Month | ||||
| PX161601080401 | Smallpox Booster 2 Date - Month | N/A | ||
| PX161601_Smallpox_Booster2_Date_Year | ||||
| PX161601080403 | Smallpox Booster 2 Date - Year | N/A | ||
| PX161601_Smallpox_Booster3_Age | ||||
| PX161601080500 | Smallpox Booster 3 Age | N/A | ||
| PX161601_Smallpox_Booster3_Date_Day | ||||
| PX161601080602 | Smallpox Booster 3 Date - Day | N/A | ||
| PX161601_Smallpox_Booster3_Date_Month | ||||
| PX161601080601 | Smallpox Booster 3 Date - Month | N/A | ||
| PX161601_Smallpox_Booster3_Date_Year | ||||
| PX161601080603 | Smallpox Booster 3 Date - Year | N/A | ||
| PX161601_Tetanus_Booster1_Age | ||||
| PX161601070100 | Tetanus Booster 1 Age | N/A | ||
| PX161601_Tetanus_Booster1_Date_Day | ||||
| PX161601070202 | Tetanus Booster 1 Date - Day | N/A | ||
| PX161601_Tetanus_Booster1_Date_Month | ||||
| PX161601070201 | Tetanus Booster 1 Date - Month | N/A | ||
| PX161601_Tetanus_Booster1_Date_Year | ||||
| PX161601070203 | Tetanus Booster 1 Date - Year | N/A | ||
| PX161601_Tetanus_Booster2_Age | ||||
| PX161601070300 | Tetanus Booster 2 Age | N/A | ||
| PX161601_Tetanus_Booster2_Date_Day | ||||
| PX161601070402 | Tetanus Booster 2 Date - Day | N/A | ||
| PX161601_Tetanus_Booster2_Date_Month | ||||
| PX161601070401 | Tetanus Booster 2 Date - Month | N/A | ||
| PX161601_Tetanus_Booster2_Date_Year | ||||
| PX161601070403 | Tetanus Booster 2 Date - Year | N/A | ||
| PX161601_Tetanus_Booster3_Age | ||||
| PX161601070500 | Tetanus Booster 3 Age | N/A | ||
| PX161601_Tetanus_Booster3_Date_Day | ||||
| PX161601070602 | Tetanus Booster 3 Date - Day | N/A | ||
| PX161601_Tetanus_Booster3_Date_Month | ||||
| PX161601070601 | Tetanus Booster 3 Date - Month | N/A | ||
| PX161601_Tetanus_Booster3_Date_Year | ||||
| PX161601070603 | Tetanus Booster 3 Date - Year | N/A | ||
| PX161601_Tuberculosis_Booster1_Age | ||||
| PX161601130100 | Tuberculosis Booster 1 Age | N/A | ||
| PX161601_Tuberculosis_Booster1_Date_Day | ||||
| PX161601130202 | Tuberculosis Booster 1 Date - Day | N/A | ||
| PX161601_Tuberculosis_Booster1_Date_Month | ||||
| PX161601130201 | Tuberculosis Booster 1 Date - Month | N/A | ||
| PX161601_Tuberculosis_Booster1_Date_Year | ||||
| PX161601130203 | Tuberculosis Booster 1 Date - Year | N/A | ||
| PX161601_Tuberculosis_Booster2_Age | ||||
| PX161601130300 | Tuberculosis Booster 2 Age | N/A | ||
| PX161601_Tuberculosis_Booster2_Date_Day | ||||
| PX161601130402 | Tuberculosis Booster 2 Date - Day | N/A | ||
| PX161601_Tuberculosis_Booster2_Date_Month | ||||
| PX161601130401 | Tuberculosis Booster 2 Date - Month | N/A | ||
| PX161601_Tuberculosis_Booster2_Date_Year | ||||
| PX161601130403 | Tuberculosis Booster 2 Date - Year | N/A | ||
| PX161601_Tuberculosis_Booster3_Age | ||||
| PX161601130500 | Tuberculosis Booster 3 Age | N/A | ||
| PX161601_Tuberculosis_Booster3_Date_Day | ||||
| PX161601130602 | Tuberculosis Booster 3 Date - Day | N/A | ||
| PX161601_Tuberculosis_Booster3_Date_Month | ||||
| PX161601130601 | Tuberculosis Booster 3 Date - Month | N/A | ||
| PX161601_Tuberculosis_Booster3_Date_Year | ||||
| PX161601130603 | Tuberculosis Booster 3 Date - Year | N/A | ||
| PX161601_Typhoid_Booster1_Age | ||||
| PX161601090100 | Typhoid Booster 1 Age | N/A | ||
| PX161601_Typhoid_Booster1_Date_Day | ||||
| PX161601090202 | Typhoid Booster 1 Date - Day | N/A | ||
| PX161601_Typhoid_Booster1_Date_Month | ||||
| PX161601090201 | Typhoid Booster 1 Date - Month | N/A | ||
| PX161601_Typhoid_Booster1_Date_Year | ||||
| PX161601090203 | Typhoid Booster 1 Date - Year | N/A | ||
| PX161601_Typhoid_Booster2_Age | ||||
| PX161601090300 | Typhoid Booster 2 Age | N/A | ||
| PX161601_Typhoid_Booster2_Date_Day | ||||
| PX161601090402 | Typhoid Booster 2 Date - Day | N/A | ||
| PX161601_Typhoid_Booster2_Date_Month | ||||
| PX161601090401 | Typhoid Booster 2 Date - Month | N/A | ||
| PX161601_Typhoid_Booster2_Date_Year | ||||
| PX161601090403 | Typhoid Booster 2 Date - Year | N/A | ||
| PX161601_Typhoid_Booster3_Age | ||||
| PX161601090500 | Typhoid Booster 3 Age | N/A | ||
| PX161601_Typhoid_Booster3_Date_Day | ||||
| PX161601090602 | Typhoid Booster 3 Date - Day | N/A | ||
| PX161601_Typhoid_Booster3_Date_Month | ||||
| PX161601090601 | Typhoid Booster 3 Date - Month | N/A | ||
| PX161601_Typhoid_Booster3_Date_Year | ||||
| PX161601090603 | Typhoid Booster 3 Date - Year | N/A | ||
| PX161601__Other_Booster3_Date_Year | ||||
| PX161601150603 | Other Booster 3 Date -Year | N/A | ||
Infectious Diseases and Immunity
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