Item
Sex
text
C0079399 (UMLS CUI [1])
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])
Item
Country of Exposure/Other
text
C3176936 (UMLS CUI [1])
Code List
Country of Exposure/Other
CL Item
Exposure country not ascertainable (Exposure country not ascertainable)
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])
Code List
Reason for Travel Related to Current Illness (Check One)
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)
Item
Risk Level Qualifier (Check One)
text
C3259260 (UMLS CUI [1])
Code List
Risk Level Qualifier (Check One)
CL Item
Pre-arranged or organized travel (Pre-arranged or organized travel )
CL Item
Risk travel (Risk travel)
CL Item
Expatriate (Expatriate)
Item
Clinical Setting (Check One)
text
C3176918 (UMLS CUI [1])
Code List
Clinical Setting (Check One)
CL Item
Seen during travel (Seen during travel )
CL Item
Seen after travel (Seen after travel )
CL Item
Immigration travel only (Immigration travel only)
Item
Patient Type (Check One)
text
C1550335 (UMLS CUI [1])
Code List
Patient Type (Check One)
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
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])
Item
Main presenting symptom [PhenX]
text
C3177142 (UMLS CUI [1])
Code List
Main presenting symptom [PhenX]
CL Item
Cardiac/MI (Cardiac/MI)
CL Item
Fatigue (Fatigue)
CL Item
Gastrointestinal (Gastrointestinal)
CL Item
Genitourinary (Genitourinary )
CL Item
Lymphatic (Lymphatic)
CL Item
Musculoskeletal (Musculoskeletal )
CL Item
Neurologic (Neurologic)
CL Item
Psychologic (Psychologic)
CL Item
Respiratory (Respiratory)
presenting symptom other
Item
Main Presenting Symptoms If "Other," Specify:
text
C3177142 (UMLS CUI [1,1])
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])
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])
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])
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])
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])
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])
working diagnosis number
Item
Working diagnosis number [PhenX]
text
C0332135 (UMLS CUI [1])
Item
Working Diagnosis 1 Status (circle one)
text
C3259269 (UMLS CUI [1])
Code List
Working Diagnosis 1 Status (circle one)
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])