Information:
Error:
ID
15314
Description
From the Global Surveillance Network of the International Society of Travel Medicine (ISTM) and the Centers for Disease Control and Prevention (CDC), The GeoSentinel protocol is a self-reported questionnaire that collects information on a respondent’s recent (within the last 6 months) and previous (within the last 5 years) travel history. It also provides a template for the clinician to use in assessing the exposure details. ODM derived from: https://cde.nlm.nih.gov Primary source: https://www.phenxtoolkit.org/ Recent publication: Hendershot, T., Pan, H., Haines, J., Harlan, W.R., Marazita, M.L., McCarty, C.A., Ramos, E.M., and Hamilton, C.M. (2015) Using the PhenX toolkit to add standard measures to a study. Curr. Protoc. Hum. Genet. 86:1.21.1-1.21.17. doi: 10.1002/0471142905.hg0121s86 Permission to publish granted by Carol M. Hamilton.
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Keywords
Versions (1)
- 9/27/17 9/27/17 -
Uploaded on
September 27, 2017
DOI
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License
Creative Commons BY-NC 3.0
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International Travel History Protocol PhenX Toolkit
International Travel History Protocol PhenX Toolkit
- StudyEvent: SE
Similar models
International Travel History Protocol PhenX Toolkit
- StudyEvent: SE
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
PhenX - international travel history protocol
C3169251 (UMLS CUI-1)
CL Item
Male (1)
CL Item
Female (2)
age
Item
Age
integer
C0001779 (UMLS CUI [1])
Date assessment information completed
Item
Date assessment information completed [OASIS]
date
C1830436 (UMLS CUI [1])
birthplace
Item
Birthplace
text
C0032040 (UMLS CUI [1])
primary country of residency before age 10
Item
Primary country of residency before age 10
text
C3259416 (UMLS CUI [1])
country of citizenship
Item
Country of citizenship
text
C3176934 (UMLS CUI [1])
country of current residence
Item
Country of Current Residence
text
C3258975 (UMLS CUI [1])
immigrant
Item
Immigrant
boolean
C0282163 (UMLS CUI [1])
Date arrived USA
Item
If you were not born in USA, indicate as closely as possible the date you first arrived here:
date
C3258977 (UMLS CUI [1])
CL Item
Exposure country not ascertainable (Exposure country not ascertainable)
CL Item
Ship (Ship)
CL Item
Plane (Plane)
country exposure
Item
Country of Exposure/Other - Country 1
text
C3259257 (UMLS CUI [1])
specific place exposure
Item
More Specific Place of Exposure
text
C3259258 (UMLS CUI [1])
Item
Reason for Travel Related to Current Illness (Check One)
text
C3259259 (UMLS CUI [1])
CL Item
Tourism (Tourism)
CL Item
Business (Business)
CL Item
Missionary/volunteer/researcher/aid work (Missionary/volunteer/researcher/aid work )
CL Item
Student (Student)
CL Item
Medical tourism (Medical tourism)
CL Item
Immigration (Immigration)
CL Item
Visiting friends & relatives (Visiting friends & relatives )
CL Item
Military (Military)
CL Item
Pre-arranged or organized travel (Pre-arranged or organized travel )
CL Item
Risk travel (Risk travel)
CL Item
Expatriate (Expatriate)
CL Item
Seen during travel (Seen during travel )
CL Item
Seen after travel (Seen after travel )
CL Item
Immigration travel only (Immigration travel only)
CL Item
Inpatient (Inpatient)
CL Item
Outpatient (Outpatient)
CL Item
Teleconsult-outpatient (Teleconsult-outpatient)
CL Item
Teleconsult-inpatient (Teleconsult-inpatient)
Item
Did the patient have a pre-travel encounter with a health care provider? (Check One)
text
C3259263 (UMLS CUI [1])
Code List
Did the patient have a pre-travel encounter with a health care provider? (Check One)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Don't know (Don't know)
abnormal lab test
Item
Main Presenting Symptoms (Check at least one symptom below, but include all symptoms that apply): Abnormal Lab Test
boolean
C0438215 (UMLS CUI [1])
asymptomatic screening
Item
Main Presenting Symptoms (Check at least one symptom below, but include all symptoms that apply): Asymptomatic Screening
boolean
C3176875 (UMLS CUI [1])
CL Item
Cardiac/MI (Cardiac/MI)
CL Item
Fatigue (Fatigue)
CL Item
Gastrointestinal (Gastrointestinal)
CL Item
Genitourinary (Genitourinary )
CL Item
HEENT (HEENT)
CL Item
Lymphatic (Lymphatic)
CL Item
Musculoskeletal (Musculoskeletal )
CL Item
Neurologic (Neurologic)
CL Item
Psychologic (Psychologic)
CL Item
Respiratory (Respiratory)
CL Item
Skin (Skin )
CL Item
Other (Other)
presenting symptom other
Item
Main Presenting Symptoms If "Other," Specify:
text
C3177142 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,2])
trip number
Item
Trip number [PhenX]
text
C3259239 (UMLS CUI [1])
country number
Item
Country number
integer
C3259240 (UMLS CUI [1])
trip start date
Item
History of Recent Travel - Trip Start Date
date
C0808070 (UMLS CUI [1])
trip end date
Item
History of Recent Travel - Trip End Date
date
C0806020 (UMLS CUI [1])
country 1
Item
History of Previous Travel - Country 1 - Check if travelled to country this year.
boolean
C0454664 (UMLS CUI [1])
country 2
Item
History of Previous Travel - Country 1 - Check if travelled to country last year.
boolean
C0454664 (UMLS CUI [1])
country 3
Item
History of Previous Travel - Country 1 - Check if travelled to country two years ago.
boolean
C0454664 (UMLS CUI [1])
country 4
Item
History of Previous Travel - Country 1 - Check if travelled to country three years ago.
boolean
C0454664 (UMLS CUI [1])
country 5
Item
History of Previous Travel - Country 1 - Check if travelled to country four years ago.
boolean
C0454664 (UMLS CUI [1])
country 6
Item
History of Previous Travel - Country 1 - Check if travelled to country five years ago.
boolean
C0454664 (UMLS CUI [1])
longer than 30 consecutive days this year 1
Item
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days this year
boolean
C0023303 (UMLS CUI [1,1])
C4028326 (UMLS CUI [1,2])
C4028326 (UMLS CUI [1,2])
longer than 30 consecutive days last year 2
Item
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days last year
boolean
C0023303 (UMLS CUI [1,1])
C4028326 (UMLS CUI [1,2])
C4028326 (UMLS CUI [1,2])
longer than 30 consecutive days two years ago 3
Item
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days two years ago
boolean
C0023303 (UMLS CUI [1,1])
C4028326 (UMLS CUI [1,2])
C4028326 (UMLS CUI [1,2])
longer than 30 consecutive days three years ago 4
Item
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days three years ago
boolean
C0023303 (UMLS CUI [1,1])
C4028326 (UMLS CUI [1,2])
C4028326 (UMLS CUI [1,2])
longer than 30 consecutive days four years ago 5
Item
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days four years ago
boolean
C0023303 (UMLS CUI [1,1])
C4028326 (UMLS CUI [1,2])
C4028326 (UMLS CUI [1,2])
longer than 30 consecutive days five years ago 6
Item
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days five years ago
boolean
C0023303 (UMLS CUI [1,1])
C4028326 (UMLS CUI [1,2])
C4028326 (UMLS CUI [1,2])
working diagnosis number
Item
Working diagnosis number [PhenX]
text
C0332135 (UMLS CUI [1])
CL Item
Confirmed (Confirmed)
CL Item
Probable (Probable)
CL Item
Suspected (Suspected)
CL Item
Exclusion of (Exclusion of)
CL Item
Status post (confirmed) (Status post (confirmed))
CL Item
Status post (probable) (Status post (probable))
CL Item
Status post (suspected) (Status post (suspected))
disease not travel related
Item
Check this box if patient was primarily diagnosed with an infection or disease that was acquired or existed at home prior to departure or which was acquired after travel but prior to the clinic visit.
boolean
C3259270 (UMLS CUI [1])