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Protocol - Personal History of Allergies, Infectious Diseases, and Immunizations - Adult

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Description:

This protocol is a self- or proxy-administered personal health record from the American Health Information Management Association (AHIMA). The respondent is asked to provide details on the following categories: Medical History, Infectious Diseases, Immunizations, Allergies/Drug Sensitivities, Health Log, Doctor Visits, Hospitalizations, Surgeries, Lab or Imaging, Medical Devices, and Physical/Occupational Therapy.

Protocol:

A. Medical History (Check appropriate)

[ ] Acquired Immunodeficiency Syndrome (AIDS) or HIV Positive:

Date of Onset

[ ] High Blood Pressure

Date of Onset

[ ] Arthritis

[ ] Hypoglycemia

[ ] Asthma

[ ] Jaundice

[ ] Bronchitis

[ ] Kidney Disease

[ ] Cancer

[ ] Low Blood Pressure

[ ] Chlamydia

[ ] Mental Retardation

[ ] Diabetes

[ ] Pain or Pressure in Chest

[ ] Dizziness

[ ] Palpitations

[ ] Emphysema

[ ] Periods of Unconsciousness

[ ] Epilepsy

[ ] Rheumatic Fever

[ ] Eye Problem

[ ] Rheumatism

[ ] Fainting

[ ] Seizures

[ ] Frequent or Severe Headaches

[ ] Shortness of Breath

[ ] Glaucoma

[ ] Stomach Liver or Intestinal Problems

[ ] Gonorrhea

[ ] Syphilis

[ ] Hearing Impairment

[ ] Tuberculosis

[ ] Heart Condition

[ ] Tumor

[ ] Hemodialysis

[ ] Thyroid Problems

[ ] Herpes

[ ] Urinary Tract Infection

[ ] High Blood Cholesterol

[ ] Other

B. Infectious Disease

Disease

Age

Date

Remarks

Chicken Pox

Hepatitis

Measles

Mumps

Pertussis/

Whooping Cough

Pneumonia

Polio

Rubella

Scarlet Fever

Other

C. 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





























D. Allergies/Drug Sensitivities

Allergy/

Sensitivity Type

(include medications, foods, environmental, or other)

Reaction

Date last Occurred

Treatment

















































E. Health Log (Noninfectious major illnesses. Include pregnancies and childbirth.)

Date Diagnosed

Doctor

Nature of Health Problems

Age of Onset

Condition Status

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





















































































F. Doctor Visits

Date

Doctor

Reason

Diagnosis

























































G. Hospitalizations

Hospitalization Type (includes emergency room visits)

Diagnosis

Admission Date

Discharge Date

Doctor


Hospital


Reason


Complications


Hospitalization Type (includes emergency room visits)

Diagnosis

Admission Date


Doctor


Hospital


Reason

Complications


Hospitalization Type (includes emergency room visits)

Diagnosis

Admission Date


Doctor


Hospital


Reason

Complications


H. Surgeries

Date

Doctor

Results


Hospital


Surgical Procedure


Description


Comments







Date

Doctor

Results


Hospital


Surgical Procedure


Description


Comments







Date

Doctor

Results


Hospital


Surgical Procedure



Description


Comments





I. Lab or Imaging (e.g., x-ray, MRI, mammogram)

Test Type

Date


Test Type


Date


Requesting Doctor

Administered by


Requesting Doctor

Administered by

Reason


Reason



Result


Result







Test Type

Date


Test Type

Date


Requesting Doctor

Administered by


Requesting Doctor

Administered by

Reason


Reason



Result

Result





J. Medical Devices (e.g., pacemaker, insulin pumps, breathing devices)

Device Type


Doctor

Device Type

Doctor

Hospital


Date

Hospital

Date



Reason





K. Physical/Occupation Therapy

Therapy Type

Start Date

Stop Date

Frequency

Therapist

         
         
         
         
         
       
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:

Adult

Participants:

Adults, aged 18 years and older

Specific Instructions:

Rosa's Law, enacted in October 2010, changes references in federal laws and acts from "mental retardation" to "intellectual disability," and references to a "mentally retarded individual" to "an individual with an intellectual disability." The PhenX Working Group notes that this protocol was developed and tested using previously accepted terminology. Replacing this terminology with the newly enacted standard is at the researcher's discretion.

Selection Rationale

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 Hypersensitivity Personal Medical History Assessment Description Text 3151220 CDE Browser
Common Data Elements (CDE) Adult Infectious Disorder Personal Medical History Assessment Description Text 3151221 CDE Browser
Common Data Elements (CDE) Adult Immunization Personal Medical History Assessment Description Text 3151222 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Hx allerg infect immun adult proto 62895-8 LOINC
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. Sections F, G, H, I, L, N, O, P, Q, R, S.

General References

None

Protocol ID:

161602

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX161602_AIDS PX161602010200 Acquired Immunodeficiency Syndrome (AIDS) or HIV Positive 4 Variable Mapping
PX161602_AIDS_Date_Of_Onset_Day PX161602010202 Acquired Immunodeficiency Syndrome (AIDS) or HIV Positive Date of Onset - Day 4 N/A
PX161602_AIDS_Date_Of_Onset_Month PX161602010201 Acquired Immunodeficiency Syndrome (AIDS) or HIV Positive Date of Onset - Month 4 N/A
PX161602_AIDS_Date_Of_Onset_Year PX161602010203 Acquired Immunodeficiency Syndrome (AIDS) or HIV Positive Date of Onset -Year 4 Variable Mapping
PX161602_Allergy/Sensitivity_1_Date_Last_Occurred_Day PX161602230302 Allergy/Sensitivity 1 Date Last Occurred - Day 4 N/A
PX161602_Allergy/Sensitivity_1_Date_Last_Occurred_Month PX161602230301 Allergy/Sensitivity 1 Date Last Occurred - Month 4 N/A
PX161602_Allergy/Sensitivity_1_Date_Last_Occurred_Year PX161602230303 Allergy/Sensitivity 1 Date Last Occurred - Year 4 N/A
PX161602_Allergy/Sensitivity_1_Reaction PX161602230200 Allergy/Sensitivity 1 Reaction 4 N/A
PX161602_Allergy/Sensitivity_1_Treatment PX161602230400 Allergy/Sensitivity 1 Treatment 4 N/A
PX161602_Allergy/Sensitivity_1_Type PX161602230100 Allergy/Sensitivity 1 Type 4 N/A
PX161602_Allergy/Sensitivity_2_Date_Last_Occurred_Day PX161602240302 Allergy/Sensitivity 2 Date Last Occurred - Day 4 N/A
PX161602_Allergy/Sensitivity_2_Date_Last_Occurred_Month PX161602240301 Allergy/Sensitivity 2 Date Last Occurred - Month 4 N/A
PX161602_Allergy/Sensitivity_2_Date_Last_Occurred_Year PX161602240303 Allergy/Sensitivity 2 Date Last Occurred - Year 4 N/A
PX161602_Allergy/Sensitivity_2_Reaction PX161602240200 Allergy/Sensitivity 2 Reaction 4 N/A
PX161602_Allergy/Sensitivity_2_Treatment PX161602240400 Allergy/Sensitivity 2 Treatment 4 N/A
PX161602_Allergy/Sensitivity_2_Type PX161602240100 Allergy/Sensitivity 2 Type 4 N/A
PX161602_Allergy/Sensitivity_3_Date_Last_Occurred_Day PX161602250302 Allergy/Sensitivity 3 Date Last Occurred - Day 4 N/A
PX161602_Allergy/Sensitivity_3_Date_Last_Occurred_Month PX161602250301 Allergy/Sensitivity 3 Date Last Occurred - Month 4 N/A
PX161602_Allergy/Sensitivity_3_Date_Last_Occurred_Year PX161602250303 Allergy/Sensitivity 3 Date Last Occurred - Year 4 N/A
PX161602_Allergy/Sensitivity_3_Reaction PX161602250200 Allergy/Sensitivity 3 Reaction 4 N/A
PX161602_Allergy/Sensitivity_3_Treatment PX161602250400 Allergy/Sensitivity 3 Treatment 4 N/A
PX161602_Allergy/Sensitivity_3_Type PX161602250100 Allergy/Sensitivity 3 Type 4 N/A
PX161602_Allergy/Sensitivity_4_Date_Last_Occurred_Day PX161602260302 Allergy/Sensitivity 4 Date Last Occurred - Day 4 N/A
PX161602_Allergy/Sensitivity_4_Date_Last_Occurred_Month PX161602260301 Allergy/Sensitivity 4 Date Last Occurred - Month 4 N/A
PX161602_Allergy/Sensitivity_4_Date_Last_Occurred_Year PX161602260303 Allergy/Sensitivity 4 Date Last Occurred - Year 4 N/A
PX161602_Allergy/Sensitivity_4_Reaction PX161602260200 Allergy/Sensitivity 4 Reaction 4 N/A
PX161602_Allergy/Sensitivity_4_Treatment PX161602260400 Allergy/Sensitivity 4 Treatment 4 N/A
PX161602_Allergy/Sensitivity_4_Type PX161602260100 Allergy/Sensitivity 4 Type 4 N/A
PX161602_Allergy/Sensitivity_5_Date_Last_Occurred_Day PX161602270302 Allergy/Sensitivity 5 Date Last Occurred - Day 4 N/A
PX161602_Allergy/Sensitivity_5_Date_Last_Occurred_Month PX161602270301 Allergy/Sensitivity 5 Date Last Occurred - Month 4 N/A
PX161602_Allergy/Sensitivity_5_Date_Last_Occurred_Year PX161602270303 Allergy/Sensitivity 5 Date Last Occurred - Year 4 N/A
PX161602_Allergy/Sensitivity_5_Reaction PX161602270200 Allergy/Sensitivity 5 Reaction 4 N/A
PX161602_Allergy/Sensitivity_5_Treatment PX161602270400 Allergy/Sensitivity 5 Treatment 4 N/A
PX161602_Allergy/Sensitivity_5_Type PX161602270100 Allergy/Sensitivity 5 Type 4 N/A
PX161602_Allergy/Sensitivity_6_Date_Last_Occurred_Day PX161602280302 Allergy/Sensitivity 6 Date Last Occurred - Day 4 N/A
PX161602_Allergy/Sensitivity_6_Date_Last_Occurred_Month PX161602280301 Allergy/Sensitivity 6 Date Last Occurred - Month 4 N/A
PX161602_Allergy/Sensitivity_6_Date_Last_Occurred_Year PX161602280303 Allergy/Sensitivity 6 Date Last Occurred - Year 4 N/A
PX161602_Allergy/Sensitivity_6_Reaction PX161602280200 Allergy/Sensitivity 6 Reaction 4 N/A
PX161602_Allergy/Sensitivity_6_Treatment PX161602280400 Allergy/Sensitivity 6 Treatment 4 N/A
PX161602_Allergy/Sensitivity_6_Type PX161602280100 Allergy/Sensitivity 6 Type 4 N/A
PX161602_Arthritis PX161602010300 Arthritis 4 Variable Mapping
PX161602_Arthritis_Date_Of_Onset_Day PX161602010302 Arthritis Date of Onset - Day 4 N/A
PX161602_Arthritis_Date_Of_Onset_Month PX161602010301 Arthritis Date of Onset - Month 4 N/A
PX161602_Arthritis_Date_Of_Onset_Year PX161602010303 Arthritis Date of Onset - Year 4 Variable Mapping
PX161602_Asthma PX161602010400 Asthma 4 Variable Mapping
PX161602_Asthma_Date_Of_Onset_Day PX161602010402 Asthma Date of Onset - Day 4 N/A
PX161602_Asthma_Date_Of_Onset_Month PX161602010401 Asthma Date of Onset - Month 4 N/A
PX161602_Asthma_Date_Of_Onset_Year PX161602010403 Asthma Date of Onset - Year 4 Variable Mapping
PX161602_Bronchitis PX161602010500 Bronchitis 4 Variable Mapping
PX161602_Bronchitis_Date_Of_Onset_Day PX161602010502 Bronchitis Date of Onset - Day 4 N/A
PX161602_Bronchitis_Date_Of_Onset_Month PX161602010501 Bronchitis Date of Onset - Month 4 N/A
PX161602_Bronchitis_Date_Of_Onset_Year PX161602010503 Bronchitis Date of Onset - Year 4 Variable Mapping
PX161602_Cancer PX161602010600 Cancer 4 Variable Mapping
PX161602_Cancer_Date_Of_Onset_Day PX161602010602 Cancer Date of Onset - Day 4 N/A
PX161602_Cancer_Date_Of_Onset_Month PX161602010601 Cancer Date of Onset - Month 4 Variable Mapping
PX161602_Cancer_Date_Of_Onset_Year PX161602010603 Cancer Date of Onset - Year 4 Variable Mapping
PX161602_ChestPain PX161602012800 Pain or Pressure in Chest 4 N/A
PX161602_ChestPain_Date_Of_Onset_Day PX161602012802 Pain or Pressure in Chest Date of Onset - Day 4 N/A
PX161602_ChestPain_Date_Of_Onset_Month PX161602012801 Pain or Pressure in Chest Date of Onset - Month 4 N/A
PX161602_ChestPain_Date_Of_Onset_Year PX161602012803 Pain or Pressure in Chest Date of Onset - Year 4 N/A
PX161602_Chicken_Pox_Age PX161602020100 Chicken Pox Age 4 N/A
PX161602_Chicken_Pox_Date_Day PX161602020202 Chicken Pox Date - Day 4 N/A
PX161602_Chicken_Pox_Date_Month PX161602020201 Chicken Pox Date - Month 4 N/A
PX161602_Chicken_Pox_Date_Year PX161602020203 Chicken Pox Date - Year 4 N/A
PX161602_Chicken_Pox_Remarks PX161602020300 Chicken Pox Remarks 4 N/A
PX161602_Chlamydia PX161602010700 Chlamydia 4 Variable Mapping
PX161602_Chlamydia_Date_Of_Onset_Day PX161602010702 Chlamydia Date of Onset - Day 4 N/A
PX161602_Chlamydia_Date_Of_Onset_Month PX161602010701 Chlamydia Date of Onset - Month 4 N/A
PX161602_Chlamydia_Date_Of_Onset_Year PX161602010703 Chlamydia Date of Onset - Year 4 N/A
PX161602_Diabetes PX161602010800 Diabetes 4 N/A
PX161602_Diabetes_Date_Of_Onset_Day PX161602010802 Diabetes Date of Onset - Day 4 N/A
PX161602_Diabetes_Date_Of_Onset_Month PX161602010801 Diabetes Date of Onset - Month 4 N/A
PX161602_Diabetes_Date_Of_Onset_Year PX161602010803 Diabetes Date of Onset - Year 4 N/A
PX161602_Diphtheria_Booster_1_Age PX161602110100 Diphtheria Booster 1 Age 4 N/A
PX161602_Diphtheria_Booster_1_Date_Day PX161602110202 Diphtheria Booster 1 Date - Day 4 N/A
PX161602_Diphtheria_Booster_1_Date_Month PX161602110201 Diphtheria Booster 1 Date - Month 4 N/A
PX161602_Diphtheria_Booster_1_Date_Year PX161602110203 Diphtheria Booster 1 Date - Year 4 N/A
PX161602_Diphtheria_Booster_2_Age PX161602110300 Diphtheria Booster 2 Age 4 N/A
PX161602_Diphtheria_Booster_2_Date_Day PX161602110402 Diphtheria Booster 2 Date - Day 4 N/A
PX161602_Diphtheria_Booster_2_Date_Month PX161602110401 Diphtheria Booster 2 Date - Month 4 N/A
PX161602_Diphtheria_Booster_2_Date_Year PX161602110403 Diphtheria Booster 2 Date - Year 4 N/A
PX161602_Diphtheria_Booster_3_Age PX161602110500 Diphtheria Booster 3 Age 4 N/A
PX161602_Diphtheria_Booster_3_Date_Day PX161602110602 Diphtheria Booster 3 Date - Day 4 N/A
PX161602_Diphtheria_Booster_3_Date_Month PX161602110601 Diphtheria Booster 3 Date - Month 4 N/A
PX161602_Diphtheria_Booster_3_Date_Year PX161602110603 Diphtheria Booster 3 Date - Year 4 N/A
PX161602_Dizziness PX161602010900 Dizziness 4 N/A
PX161602_Dizziness_Date_Of_Onset_Day PX161602010902 Dizziness Date of Onset - Day 4 N/A
PX161602_Dizziness_Date_Of_Onset_Month PX161602010901 Dizziness Date of Onset - Month 4 N/A
PX161602_Dizziness_Date_Of_Onset_Year PX161602010903 Dizziness Date of Onset - Year 4 N/A
PX161602_Doctor_Visit1_Date_Day PX161602360102 Doctor Visit 1 - Date - Day 4 N/A
PX161602_Doctor_Visit1_Date_Month PX161602360101 Doctor Visit 1 - Date - Month 4 N/A
PX161602_Doctor_Visit1_Date_Year PX161602360103 Doctor Visit 1 - Date - Year 4 N/A
PX161602_Doctor_Visit1_Doctor PX161602360200 Doctor Visit 1 - Doctor 4 N/A
PX161602_Doctor_Visit1_Reason PX161602360300 Doctor Visit 1 - Reason 4 N/A
PX161602_Doctor_Visit2_Date_Day PX161602370102 Doctor Visit 2 - Date - Day 4 N/A
PX161602_Doctor_Visit2_Date_Month PX161602370101 Doctor Visit 2 - Date - Month 4 N/A
PX161602_Doctor_Visit2_Date_Year PX161602370103 Doctor Visit 2 - Date - Year 4 N/A
PX161602_Doctor_Visit2_Doctor PX161602370200 Doctor Visit 2 - Doctor 4 N/A
PX161602_Doctor_Visit2_Reason PX161602370300 Doctor Visit 2 - Reason 4 N/A
PX161602_Doctor_Visit3_Date_Day PX161602380102 Doctor Visit 3 - Date - Day 4 N/A
PX161602_Doctor_Visit3_Date_Month PX161602380101 Doctor Visit 3 - Date - Month 4 N/A
PX161602_Doctor_Visit3_Date_Year PX161602380103 Doctor Visit 3 - Date - Year 4 N/A
PX161602_Doctor_Visit3_Doctor PX161602380200 Doctor Visit 3 - Doctor 4 N/A
PX161602_Doctor_Visit3_Reason PX161602380300 Doctor Visit 3 - Reason 4 N/A
PX161602_Doctor_Visit4_Date_Day PX161602390102 Doctor Visit 4 - Date - Day 4 N/A
PX161602_Doctor_Visit4_Date_Month PX161602390101 Doctor Visit 4 - Date - Month 4 N/A
PX161602_Doctor_Visit4_Date_Year PX161602390103 Doctor Visit 4 - Date - Year 4 N/A
PX161602_Doctor_Visit4_Doctor PX161602390200 Doctor Visit 4 - Doctor 4 N/A
PX161602_Doctor_Visit4_Reason PX161602390300 Doctor Visit 4 - Reason 4 N/A
PX161602_Doctor_Visit5_Date_Day PX161602400102 Doctor Visit 5 - Date - Day 4 N/A
PX161602_Doctor_Visit5_Date_Month PX161602400101 Doctor Visit 5 - Date - Month 4 N/A
PX161602_Doctor_Visit5_Date_Year PX161602400103 Doctor Visit 5 - Date - Year 4 N/A
PX161602_Doctor_Visit5_Doctor PX161602400200 Doctor Visit 5 - Doctor 4 N/A
PX161602_Doctor_Visit5_Reason PX161602400300 Doctor Visit 5 - Reason 4 N/A
PX161602_Doctor_Visit6_Date_Day PX161602410102 Doctor Visit 6 - Date - Day 4 N/A
PX161602_Doctor_Visit6_Date_Month PX161602410101 Doctor Visit 6 - Date - Month 4 N/A
PX161602_Doctor_Visit6_Date_Year PX161602410103 Doctor Visit 6 - Date - Year 4 N/A
PX161602_Doctor_Visit6_Doctor PX161602410200 Doctor Visit 6 - Doctor 4 N/A
PX161602_Doctor_Visit6_Reason PX161602410300 Doctor Visit 6 - Reason 4 N/A
PX161602_Doctor_Visit_1_Diagnosis PX161602360400 Doctor Visit 1- Diagnosis 4 N/A
PX161602_Doctor_Visit_2_Diagnosis PX161602370400 Doctor Visit 2- Diagnosis 4 N/A
PX161602_Doctor_Visit_3_Diagnosis PX161602380400 Doctor Visit 3- Diagnosis 4 N/A
PX161602_Doctor_Visit_4_Diagnosis PX161602390400 Doctor Visit 4- Diagnosis 4 N/A
PX161602_Doctor_Visit_5_Diagnosis PX161602400400 Doctor Visit 5- Diagnosis 4 N/A
PX161602_Doctor_Visit_6_Diagnosis PX161602410400 Doctor Visit 6- Diagnosis 4 N/A
PX161602_Emphysema PX161602011000 Emphysema 4 N/A
PX161602_Emphysema_Date_Of_Onset_Day PX161602011002 Emphysema Date of Onset - Day 4 N/A
PX161602_Emphysema_Date_Of_Onset_Month PX161602011001 Emphysema Date of Onset - Month 4 N/A
PX161602_Emphysema_Date_Of_Onset_Year PX161602011003 Emphysema Date of Onset - Year 4 N/A
PX161602_Epilepsy PX161602011100 Epilepsy 4 N/A
PX161602_Epilepsy_Date_Of_Onset_Day PX161602011102 Epilepsy Date of Onset - Day 4 N/A
PX161602_Epilepsy_Date_Of_Onset_Month PX161602011101 Epilepsy Date of Onset - Month 4 N/A
PX161602_Epilepsy_Date_Of_Onset_Year PX161602011103 Epilepsy Date of Onset - Year 4 N/A
PX161602_Eye_Problem PX161602011200 Eye Problem 4 N/A
PX161602_Eye_Problem_Date_Of_Onset_Day PX161602011202 Eye Problem Date of Onset - Day 4 N/A
PX161602_Eye_Problem_Date_Of_Onset_Month PX161602011201 Eye Problem Date of Onset - Month 4 N/A
PX161602_Eye_Problem_Date_Of_Onset_Year PX161602011203 Eye Problem Date of Onset - Year 4 N/A
PX161602_Fainting PX161602011300 Fainting 4 N/A
PX161602_Fainting_Date_Of_Onset_Day PX161602011302 Fainting Date of Onset - Day 4 N/A
PX161602_Fainting_Date_Of_Onset_Month PX161602011301 Fainting Date of Onset - Month 4 N/A
PX161602_Fainting_Date_Of_Onset_Year PX161602011303 Fainting Date of Onset - Year 4 N/A
PX161602_Glaucoma PX161602011500 Glaucoma 4 N/A
PX161602_Glaucoma_Date_Of_Onset_Day PX161602011502 Glaucoma Date of Onset - Day 4 N/A
PX161602_Glaucoma_Date_Of_Onset_Month PX161602011501 Glaucoma Date of Onset - Month 4 N/A
PX161602_Glaucoma_Date_Of_Onset_Year PX161602011503 Glaucoma Date of Onset -Year 4 N/A
PX161602_Gonorrhea PX161602011600 Gonorrhea 4 N/A
PX161602_Gonorrhea_Date_Of_Onset_Day PX161602011602 Gonorrhea Date of Onset - Day 4 N/A
PX161602_Gonorrhea_Date_Of_Onset_Month PX161602011601 Gonorrhea Date of Onset - Month 4 N/A
PX161602_Gonorrhea_Date_Of_Onset_Year PX161602011603 Gonorrhea Date of Onset - Year 4 N/A
PX161602_Headaches PX161602011400 Frequent or Severe Headaches 4 N/A
PX161602_Headaches_Date_Of_Onset_Day PX161602011402 Frequent or Severe Headaches Date of Onset - Day 4 N/A
PX161602_Headaches_Date_Of_Onset_Month PX161602011401 Frequent or Severe Headaches Date of Onset - Month 4 N/A
PX161602_Headaches_Date_Of_Onset_Year PX161602011403 Frequent or Severe Headaches Date of Onset - Year 4 N/A
PX161602_HearingImpairment_Date_Of_Onset_Day PX161602011702 Hearing Impairment Date of Onset - Day 4 N/A
PX161602_HearingImpairment_Date_Of_Onset_Month PX161602011701 Hearing Impairment Date of Onset - Month 4 N/A
PX161602_HearingImpairment_Date_Of_Onset_Year PX161602011703 Hearing Impairment Date of Onset - Year 4 N/A
PX161602_Hearing_Impairment PX161602011700 Hearing Impairment 4 N/A
PX161602_HeartCondition_Date_Of_Onset_Day PX161602011802 Heart Condition Date of Onset - Day 4 N/A
PX161602_HeartCondition_Date_Of_Onset_Month PX161602011801 Heart Condition Date of Onset - Month 4 N/A
PX161602_HeartCondition_Date_Of_Onset_Year PX161602011803 Heart Condition Date of Onset - Year 4 N/A
PX161602_Heart_Condition PX161602011800 Heart Condition 4 N/A
PX161602_Hemodialysis PX161602011900 Hemodialysis 4 N/A
PX161602_Hemodialysis_Date_Of_Onset_Day PX161602011902 Hemodialysis Date of Onset - Day 4 N/A
PX161602_Hemodialysis_Date_Of_Onset_Month PX161602011901 Hemodialysis Date of Onset - Month 4 N/A
PX161602_Hemodialysis_Date_Of_Onset_Year PX161602011903 Hemodialysis Date of Onset - Year 4 N/A
PX161602_HepatitisB_Booster_1_Age PX161602120100 Hepatitis B Booster 1 Age 4 N/A
PX161602_HepatitisB_Booster_1_Date_Day PX161602120202 Hepatitis B Booster 1 Date - Day 4 N/A
PX161602_HepatitisB_Booster_1_Date_Month PX161602120201 Hepatitis B Booster 1 Date - Month 4 N/A
PX161602_HepatitisB_Booster_1_Date_Year PX161602120203 Hepatitis B Booster 1 Date - Year 4 N/A
PX161602_HepatitisB_Booster_2_Age PX161602120300 Hepatitis B Booster 2 Age 4 N/A
PX161602_HepatitisB_Booster_2_Date_Day PX161602120402 Hepatitis B Booster 2 Date - Day 4 N/A
PX161602_HepatitisB_Booster_2_Date_Month PX161602120401 Hepatitis B Booster 2 Date - Month 4 N/A
PX161602_HepatitisB_Booster_2_Date_Year PX161602120403 Hepatitis B Booster 2 Date - Year 4 N/A
PX161602_HepatitisB_Booster_3_Age PX161602120500 Hepatitis B Booster 3 Age 4 N/A
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PX161602_HepatitisB_Booster_3_Date_Month PX161602120601 Hepatitis B Booster 3 Date - Month 4 N/A
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PX161602_Hepatitis_B_Age PX161602030100 Hepatitis Age 4 N/A
PX161602_Hepatitis_B_Date_Day PX161602030202 Hepatitis B Date - Day 4 N/A
PX161602_Hepatitis_B_Date_Month PX161602030201 Hepatitis B Date - Month 4 N/A
PX161602_Hepatitis_B_Date_Year PX161602030203 Hepatitis B Date - Year 4 N/A
PX161602_Hepatitis_Remarks PX161602030300 Hepatitis Remarks 4 N/A
PX161602_Herpes PX161602012000 Herpes 4 N/A
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PX161602_Herpes_Date_Of_Onset_Month PX161602012001 Herpes Date of Onset - Month 4 N/A
PX161602_Herpes_Date_Of_Onset_Year PX161602012003 Herpes Date of Onset - Year 4 N/A
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PX161602_HighBloodCholesterol_Date_Of_Onset_Year PX161602012103 High Blood Cholesterol Date of Onset - Year 4 N/A
PX161602_HighBloodPressure_Date_Of_Onset_Day PX161602012202 High Blood Pressure Date of Onset - Day 4 N/A
PX161602_HighBloodPressure_Date_Of_Onset_Month PX161602012201 High Blood Pressure Date of Onset - Month 4 N/A
PX161602_HighBloodPressure_Date_Of_Onset_Year PX161602012203 High Blood Pressure Date of Onset - Year 4 N/A
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PX161602_High_Blood_Pressure PX161602012200 High Blood Pressure 4 N/A
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PX161602_Hospitalization_1_Discharge_Date_Month PX161602420302 Hospitalization 1 - Discharge Date - Month 4 N/A
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PX161602_Hospitalization_1_Doctor PX161602420400 Hospitalization 1 - Doctor 4 N/A
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PX161602_Hospitalization_2_Admission_Date_Day PX161602430201 Hospitalization 2 - Admission Date - Day 4 N/A
PX161602_Hospitalization_2_Admission_Date_Month PX161602430202 Hospitalization 2 - Admission Date - Month 4 N/A
PX161602_Hospitalization_2_Admission_Date_Year PX161602430203 Hospitalization 2 - Admission Date - Year 4 N/A
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PX161602_Hospitalization_2_Discharge_Date_Day PX161602430301 Hospitalization 2 - Discharge Date - Day 4 N/A
PX161602_Hospitalization_2_Discharge_Date_Month PX161602430302 Hospitalization 2 - Discharge Date - Month 4 N/A
PX161602_Hospitalization_2_Discharge_Date_Year PX161602430303 Hospitalization 2 - Discharge Date - Year 4 N/A
PX161602_Hospitalization_2_Doctor PX161602430400 Hospitalization 2 - Doctor 4 N/A
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PX161602_Hospitalization_3_Admission_Date_Month PX161602440202 Hospitalization 3 - Admission Date - Month 4 N/A
PX161602_Hospitalization_3_Admission_Date_Year PX161602440203 Hospitalization 3 - Admission Date - Year 4 N/A
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PX161602_Hospitalization_3_Discharge_Date_Month PX161602440302 Hospitalization 3 - Discharge Date - Month 4 N/A
PX161602_Hospitalization_3_Discharge_Date_Year PX161602440303 Hospitalization 3 - Discharge Date - Year 4 N/A
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PX161602_Hospitalization_3_Hospital PX161602440500 Hospitalization 3 - Hospital 4 N/A
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PX161602_Hypoglycemia PX161602012300 Hypoglycemia 4 N/A
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PX161602_Jaundice PX161602012400 Jaundice 4 N/A
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PX161602_Kidney_Disease PX161602012500 Kidney Disease 4 N/A
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PX161602_Low_Blood_Pressure PX161602012600 Low Blood Pressure 4 N/A
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PX161602_Measles_Remarks PX161602040300 Measles Remarks 4 N/A
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PX161602_Medical_Device_1_Doctor PX161602520200 Medical Device 1 - Doctor 4 N/A
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PX161602_Medical_Device_2_Date_Year PX161602530403 Medical Device 2 - Date - Year 4 N/A
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PX161602_MentalRetardation_Date_Of_Onset_Day PX161602012702 Mental Retardation Date of Onset - Day 4 N/A
PX161602_MentalRetardation_Date_Of_Onset_Month PX161602012701 Mental Retardation Date of Onset - Month 4 N/A
PX161602_MentalRetardation_Date_Of_Onset_Year PX161602012703 Mental Retardation Date of Onset - Year 4 N/A
PX161602_Mental_Retardation PX161602012700 Mental Retardation 4 N/A
PX161602_Mumps_Age PX161602050100 Mumps Age 4 N/A
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PX161602_Mumps_Date_Day PX161602050202 Mumps Date - Day 4 N/A
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PX161602_NoninfectiousMajorIllness2_Date_Diagnosed_Day PX161602300102 Noninfectious Major Illness 2 - Date Diagnosed - Day 4 N/A
PX161602_NoninfectiousMajorIllness2_Date_Diagnosed_Month PX161602300101 Noninfectious Major Illness 2 - Date Diagnosed - Month 4 N/A
PX161602_NoninfectiousMajorIllness2_Date_Diagnosed_Year PX161602300103 Noninfectious Major Illness 2 - Date Diagnosed - Year 4 N/A
PX161602_NoninfectiousMajorIllness2_Nature_Of_Health_Problems PX161602300400 Noninfectious Major Illness 2 - Nature of Health Problems 4 N/A
PX161602_NoninfectiousMajorIllness2_Remarks PX161602300700 Noninfectious Major Illness 2 - Remarks 4 N/A
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PX161602_NoninfectiousMajorIllness3_Condition_Status PX161602310500 Noninfectious Major Illness 3 - Condition Status 4 N/A
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PX161602_NoninfectiousMajorIllness3_Date_Diagnosed_Month PX161602310101 Noninfectious Major Illness 3 - Date Diagnosed - Month 4 N/A
PX161602_NoninfectiousMajorIllness3_Date_Diagnosed_Year PX161602310103 Noninfectious Major Illness 3 - Date Diagnosed - Year 4 N/A
PX161602_NoninfectiousMajorIllness3_Doctor PX161602310200 Noninfectious Major Illness 3 - Doctor 4 N/A
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PX161602_NoninfectiousMajorIllness3_Remarks PX161602310600 Noninfectious Major Illness 3 - Remarks 4 N/A
PX161602_NoninfectiousMajorIllness4_Age_Of_Onset PX161602320400 Noninfectious Major Illness 4 - Age of Onset 4 N/A
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PX161602_NoninfectiousMajorIllness4_Date_Diagnosed_Day PX161602320102 Noninfectious Major Illness 4 - Date Diagnosed - Day 4 N/A
PX161602_NoninfectiousMajorIllness4_Date_Diagnosed_Month PX161602320101 Noninfectious Major Illness 4 - Date Diagnosed - Month 4 N/A
PX161602_NoninfectiousMajorIllness4_Date_Diagnosed_Year PX161602320103 Noninfectious Major Illness 4 - Date Diagnosed - Year 4 N/A
PX161602_NoninfectiousMajorIllness4_Doctor PX161602320200 Noninfectious Major Illness 4 - Doctor 4 N/A
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PX161602_NoninfectiousMajorIllness5_Date_Diagnosed_Month PX161602330101 Noninfectious Major Illness 5 - Date Diagnosed - Month 4 N/A
PX161602_NoninfectiousMajorIllness5_Date_Diagnosed_Year PX161602330103 Noninfectious Major Illness 5 - Date Diagnosed - Year 4 N/A
PX161602_NoninfectiousMajorIllness5_Doctor PX161602330200 Noninfectious Major Illness 5 - Doctor 4 N/A
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PX161602_NoninfectiousMajorIllness5_Remarks PX161602330600 Noninfectious Major Illness 5 - Remarks 4 N/A
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PX161602_NoninfectiousMajorIllness6_Date_Diagnosed_Month PX161602340101 Noninfectious Major Illness 6 - Date Diagnosed - Month 4 N/A
PX161602_NoninfectiousMajorIllness6_Date_Diagnosed_Year PX161602340103 Noninfectious Major Illness 6 - Date Diagnosed - Year 4 N/A
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PX161602_NoninfectiousMajorIllness6_Remarks PX161602340600 Noninfectious Major Illness 6 - Remarks 4 N/A
PX161602_NoninfectiousMajorIllness7_Age_Of_Onset PX161602350400 Noninfectious Major Illness 7 - Age of Onset 4 N/A
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PX161602_NoninfectiousMajorIllness7_Date_Diagnosed_Month PX161602350101 Noninfectious Major Illness 7 - Date Diagnosed - Month 4 N/A
PX161602_NoninfectiousMajorIllness7_Date_Diagnosed_Year PX161602350103 Noninfectious Major Illness 7 - Date Diagnosed - Year 4 N/A
PX161602_NoninfectiousMajorIllness7_Doctor PX161602350200 Noninfectious Major Illness 7 - Doctor 4 N/A
PX161602_NoninfectiousMajorIllness7_Nature_Of_Health_Problems PX161602350300 Noninfectious Major Illness 7 - Nature of Health Problems 4 N/A
PX161602_NoninfectiousMajorIllness7_Remarks PX161602350600 Noninfectious Major Illness 7 - Remarks 4 N/A
PX161602_Other_Booster_1_Age PX161602220100 Other Booster 1 Age 4 N/A
PX161602_Other_Booster_1_Date_Day PX161602220202 Other Booster 1 Date - Day 4 N/A
PX161602_Other_Booster_1_Date_Month PX161602220201 Other Booster 1 Date - Month 4 N/A
PX161602_Other_Booster_1_Date_Year PX161602220203 Other Booster 1 Date - Year 4 N/A
PX161602_Other_Booster_2_Age PX161602220300 Other Booster 2 Age 4 N/A
PX161602_Other_Booster_2_Date_Day PX161602220402 Other Booster 2 Date - Day 4 N/A
PX161602_Other_Booster_2_Date_Month PX161602220401 Other Booster 2 Date - Month 4 N/A
PX161602_Other_Booster_2_Date_Year PX161602220403 Other Booster 2 Date - Year 4 N/A
PX161602_Other_Booster_3_Age PX161602220500 Other Booster 3 Age 4 N/A
PX161602_Other_Booster_3_Date_Day PX161602220602 Other Booster 3 Date - Day 4 N/A
PX161602_Other_Booster_3_Date_Month PX161602220601 Other Booster 3 Date - Month 4 N/A
PX161602_Other_Booster_3_Date_Year PX161602220603 Other Booster 3 Date - Year 4 N/A
PX161602_Other_Infectious_Age PX161602600100 Other Age 4 N/A
PX161602_Other_Infectious_Date_Day PX161602600202 Other Date - Day 4 N/A
PX161602_Other_Infectious_Date_Month PX161602600201 Other Date - Month 4 N/A
PX161602_Other_Infectious_Date_Year PX161602600203 Other Date - Year 4 N/A
PX161602_Other_Infectious_Remarks PX161602600300 Other Remarks 4 N/A
PX161602_Other_MedicalHistory PX161602014100 Other 4 N/A
PX161602_Other_MedicalHistory_Date_Of_Onset_Day PX161602014103 Other Date of Onset - Day 4 N/A
PX161602_Other_MedicalHistory_Date_Of_Onset_Month PX161602014102 Other Date of Onset - Month 4 N/A
PX161602_Other_MedicalHistory_Date_Of_Onset_Year PX161602014104 Other Date of Onset - Year 4 N/A
PX161602_Other_MedicalHistory_Specify PX161602014101 Other, specify 4 N/A
PX161602_Palpitations PX161602012900 Palpitations 4 N/A
PX161602_Palpitations_Date_Of_OnsetYear PX161602012903 Palpitations Date of Onset-Year 4 N/A
PX161602_Palpitations_Date_Of_Onset_Day PX161602012902 Palpitations Date of Onset- Day 4 N/A
PX161602_Palpitations_Date_Of_Onset_Month PX161602012901 Palpitations Date of Onset- Month 4 N/A
PX161602_Periods_Of_Unconsciousness PX161602013000 Periods of Unconsciousness 4 N/A
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PX161602_Pertussis/WhoopingCough_Booster_1_Date_Month PX161602150201 Pertussis/Whooping Cough Booster 1 Date - Month 4 N/A
PX161602_Pertussis/WhoopingCough_Booster_1_Date_Year PX161602150203 Pertussis/Whooping Cough Booster 1 Date - Year 4 N/A
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PX161602_Pertussis/WhoopingCough_Booster_2_Date_Month PX161602150401 Pertussis/Whooping Cough Booster 2 Date - Month 4 N/A
PX161602_Pertussis/WhoopingCough_Booster_2_Date_Year PX161602150403 Pertussis/Whooping Cough Booster 2 Date - Year 4 N/A
PX161602_Pertussis/WhoopingCough_Booster_3_Age PX161602150500 Pertussis/Whooping Cough Booster 3 Age 4 N/A
PX161602_Pertussis/WhoopingCough_Booster_3_Date_Day PX161602150602 Pertussis/Whooping Cough Booster 3 Date - Day 4 N/A
PX161602_Pertussis/WhoopingCough_Booster_3_Date_Month PX161602150601 Pertussis/Whooping Cough Booster 3 Date - Month 4 N/A
PX161602_Pertussis/WhoopingCough_Booster_3_Date_Year PX161602150603 Pertussis/Whooping Cough Booster 3 Date - Year 4 N/A
PX161602_Pertussis/Whooping_Cough_Age PX161602060100 Pertussis/Whooping Cough Age 4 N/A
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PX161602_Pertussis/Whooping_Cough_Date_Month PX161602060201 Pertussis/Whooping Cough Date - Month 4 N/A
PX161602_Pertussis/Whooping_Cough_Date_Year PX161602060203 Pertussis/Whooping Cough Date - Year 4 N/A
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PX161602_Physical/OccupationTherapy_1_Start_Date_Month PX161602540202 Physical/Occupation Therapy 1 - Start Date - Month 4 N/A
PX161602_Physical/OccupationTherapy_1_Start_Date_Year PX161602540304 Physical/Occupation Therapy 1 - Start Date - Year 4 N/A
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PX161602_Physical/OccupationTherapy_1_Stop_Date_Month PX161602540402 Physical/Occupation Therapy 1 - Stop Date - Month 4 N/A
PX161602_Physical/OccupationTherapy_1_Stop_Date_Year PX161602540403 Physical/Occupation Therapy 1 - Stop Date - Year 4 N/A
PX161602_Physical/OccupationTherapy_1_Therapist PX161602540600 Physical/Occupation Therapy 1 - Therapist 4 N/A
PX161602_Physical/OccupationTherapy_1_Therapy_Type PX161602540100 Physical/Occupation Therapy 1 - Therapy Type 4 N/A
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PX161602_Physical/OccupationTherapy_2_Start_Date_Day PX161602550201 Physical/Occupation Therapy 2 - Start Date - Day 4 N/A
PX161602_Physical/OccupationTherapy_2_Start_Date_Month PX161602550202 Physical/Occupation Therapy 2 - Start Date - Month 4 N/A
PX161602_Physical/OccupationTherapy_2_Start_Date_Year PX161602550203 Physical/Occupation Therapy 2 - Start Date - Year 4 N/A
PX161602_Physical/OccupationTherapy_2_Stop_Date_Day PX161602550301 Physical/Occupation Therapy 2 - Stop Date - Day 4 N/A
PX161602_Physical/OccupationTherapy_2_Stop_Date_Month PX161602550302 Physical/Occupation Therapy 2 - Stop Date - Month 4 N/A
PX161602_Physical/OccupationTherapy_2_Stop_Date_Year PX161602550303 Physical/Occupation Therapy 2 - Stop Date - Year 4 N/A
PX161602_Physical/OccupationTherapy_2_Therapist PX161602550500 Physical/Occupation Therapy 2 - Therapist 4 N/A
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PX161602_Physical/OccupationTherapy_3_Start_Date_Month PX161602560202 Physical/Occupation Therapy 3 - Start Date - Month 4 N/A
PX161602_Physical/OccupationTherapy_3_Start_Date_Year PX161602560203 Physical/Occupation Therapy 3 - Start Date - Year 4 N/A
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PX161602_Physical/OccupationTherapy_4_Start_Date_Month PX161602570202 Physical/Occupation Therapy 4 - Start Date - Month 4 N/A
PX161602_Physical/OccupationTherapy_4_Start_Date_Year PX161602570203 Physical/Occupation Therapy 4 - Start Date - Year 4 N/A
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PX161602_Physical/OccupationTherapy_4_Stop_Date_Month PX161602570302 Physical/Occupation Therapy 4 - Stop Date - Month 4 N/A
PX161602_Physical/OccupationTherapy_4_Stop_Date_Year PX161602570303 Physical/Occupation Therapy 4 - Stop Date - Year 4 N/A
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PX161602_Physical/OccupationTherapy_5_Start_Date_Day PX161602580201 Physical/Occupation Therapy 5 - Start Date - Day 4 N/A
PX161602_Physical/OccupationTherapy_5_Start_Date_Month PX161602580202 Physical/Occupation Therapy 5 - Start Date - Month 4 N/A
PX161602_Physical/OccupationTherapy_5_Start_Date_Year PX161602580203 Physical/Occupation Therapy 5 - Start Date - Year 4 N/A
PX161602_Physical/OccupationTherapy_5_Stop_Date_Day PX161602580301 Physical/Occupation Therapy 5 - Stop Date - Day 4 N/A
PX161602_Physical/OccupationTherapy_5_Stop_Date_Month PX161602580302 Physical/Occupation Therapy 5 - Stop Date - Month 4 N/A
PX161602_Physical/OccupationTherapy_5_Stop_Date_Year PX161602580303 Physical/Occupation Therapy 5 - Stop Date - Year 4 N/A
PX161602_Physical/OccupationTherapy_5_Therapist PX161602580500 Physical/Occupation Therapy 5 - Therapist 4 N/A
PX161602_Physical/OccupationTherapy_5_Therapy_Type PX161602580100 Physical/Occupation Therapy 5 - Therapy Type 4 N/A
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PX161602_Physical/OccupationTherapy_6_Start_Date_Day PX161602590201 Physical/Occupation Therapy 6 - Start Date - Day 4 N/A
PX161602_Physical/OccupationTherapy_6_Start_Date_Month PX161602590202 Physical/Occupation Therapy 6 - Start Date - Month 4 N/A
PX161602_Physical/OccupationTherapy_6_Start_Date_Year PX161602590203 Physical/Occupation Therapy 6 - Start Date - Year 4 N/A
PX161602_Physical/OccupationTherapy_6_Stop_Date_Day PX161602590301 Physical/Occupation Therapy 6 - Stop Date - Day 4 N/A
PX161602_Physical/OccupationTherapy_6_Stop_Date_Month PX161602590302 Physical/Occupation Therapy 6 - Stop Date - Month 4 N/A
PX161602_Physical/OccupationTherapy_6_Stop_Date_Year PX161602590303 Physical/Occupation Therapy 6 - Stop Date - Year 4 N/A
PX161602_Physical/OccupationTherapy_6_Therapy_Type PX161602590100 Physical/Occupation Therapy 6 - Therapy Type 4 N/A
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PX161602_Pneumonia_Date_Year PX161602070203 Pneumonia Date - Year 4 N/A
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PX161602_Polio_Age PX161602080100 Polio Age 4 N/A
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PX161602_Polio_Booster_1_Date_Month PX161602160201 Polio Booster 1 Date - Month 4 N/A
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PX161602_Polio_Booster_2_Date_Month PX161602160401 Polio Booster 2 Date - Month 4 N/A
PX161602_Polio_Booster_2_Date_Year PX161602160403 Polio Booster 2 Date - Year 4 N/A
PX161602_Polio_Booster_3_Age PX161602160500 Polio Booster 3 Age 4 N/A
PX161602_Polio_Booster_3_Date_Day PX161602160602 Polio Booster 3 Date - Day 4 N/A
PX161602_Polio_Booster_3_Date_Month PX161602160601 Polio Booster 3 Date - Month 4 N/A
PX161602_Polio_Booster_3_Date_Year PX161602160603 Polio Booster 3 Date - Year 4 N/A
PX161602_Polio_Date_Day PX161602080202 Polio Date - Day 4 N/A
PX161602_Polio_Date_Month PX161602080201 Polio Date - Month 4 N/A
PX161602_Polio_Date_Year PX161602080203 Polio Date - Year 4 N/A
PX161602_Polio_Remarks PX161602080300 Polio Remarks 4 N/A
PX161602_RheumaticFever_Date_Of_Onset_Day PX161602013102 Rheumatic Fever Date of Onset - Day 4 N/A
PX161602_RheumaticFever_Date_Of_Onset_Month PX161602013101 Rheumatic Fever Date of Onset - Month 4 N/A
PX161602_RheumaticFever_Date_Of_Onset_Year PX161602013103 Rheumatic Fever Date of Onset - Year 4 N/A
PX161602_Rheumatic_Fever PX161602013100 Rheumatic Fever 4 N/A
PX161602_Rheumatism PX161602013200 Rheumatism 4 N/A
PX161602_Rheumatism_Date_Of_Onset_Day PX161602013202 Rheumatism Date of Onset - Day 4 N/A
PX161602_Rheumatism_Date_Of_Onset_Month PX161602013201 Rheumatism Date of Onset - Month 4 N/A
PX161602_Rheumatism_Date_Of_Onset_Year PX161602013203 Rheumatism Date of Onset - Year 4 N/A
PX161602_Rubella_Age PX161602090100 Rubella Age 4 N/A
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PX161602_Rubella_Booster_1_Date_Month PX161602170201 Rubella Booster 1 Date - Month 4 N/A
PX161602_Rubella_Booster_1_Date_Year PX161602170203 Rubella Booster 1 Date - Year 4 N/A
PX161602_Rubella_Booster_2_Age PX161602170300 Rubella Booster 2 Age 4 N/A
PX161602_Rubella_Booster_2_Date_Day PX161602170402 Rubella Booster 2 Date - Day 4 N/A
PX161602_Rubella_Booster_2_Date_Month PX161602170401 Rubella Booster 2 Date - Month 4 N/A
PX161602_Rubella_Booster_2_Date_Year PX161602170403 Rubella Booster 2 Date - Year 4 N/A
PX161602_Rubella_Booster_3_Age PX161602170500 Rubella Booster 3 Age 4 N/A
PX161602_Rubella_Booster_3_Date_Day PX161602170602 Rubella Booster 3 Date - Day 4 N/A
PX161602_Rubella_Booster_3_Date_Month PX161602170601 Rubella Booster 3 Date - Month 4 N/A
PX161602_Rubella_Booster_3_Date_Year PX161602170603 Rubella Booster 3 Date - Year 4 N/A
PX161602_Rubella_Date_Day PX161602090202 Rubella Date - Day 4 N/A
PX161602_Rubella_Date_Month PX161602090201 Rubella Date - Month 4 N/A
PX161602_Rubella_Date_Year PX161602090203 Rubella Date - Year 4 N/A
PX161602_Rubella_Remarks PX161602090300 Rubella Remarks 4 N/A
PX161602_Scarlet_Fever_Age PX161602100100 Scarlet Fever Age 4 N/A
PX161602_Scarlet_Fever_Date_Day PX161602100202 Scarlet Fever Date - Day 4 N/A
PX161602_Scarlet_Fever_Date_Month PX161602100201 Scarlet Fever Date - Month 4 N/A
PX161602_Scarlet_Fever_Date_Year PX161602100203 Scarlet Fever Date - Year 4 N/A
PX161602_Scarlet_Fever_Remarks PX161602100300 Scarlet Fever Remarks 4 N/A
PX161602_Seizures PX161602013300 Seizures 4 N/A
PX161602_Seizures_Date_Of_Onset_Day PX161602013302 Seizures Date of Onset - Day 4 N/A
PX161602_Seizures_Date_Of_Onset_Month PX161602013301 Seizures Date of Onset - Month 4 N/A
PX161602_Seizures_Date_Of_Onset_Year PX161602013303 Seizures Date of Onset - Year 4 N/A
PX161602_ShortnessOfBreath_Date_Of_Onset_Day PX161602013402 Shortness of Breath Date of Onset - Day 4 N/A
PX161602_ShortnessOfBreath_Date_Of_Onset_Month PX161602013401 Shortness of Breath Date of Onset - Month 4 N/A
PX161602_ShortnessOfBreath_Date_Of_Onset_Year PX161602013403 Shortness of Breath Date of Onset - Year 4 N/A
PX161602_Shortness_Of_Breath PX161602013400 Shortness of Breath 4 N/A
PX161602_Smallpox_Booster_1_Age PX161602180100 Smallpox Booster 1 Age 4 N/A
PX161602_Smallpox_Booster_1_Date_Day PX161602180202 Smallpox Booster 1 Date - Day 4 N/A
PX161602_Smallpox_Booster_1_Date_Month PX161602180201 Smallpox Booster 1 Date - Month 4 N/A
PX161602_Smallpox_Booster_1_Date_Year PX161602180203 Smallpox Booster 1 Date - Year 4 N/A
PX161602_Smallpox_Booster_2_Age PX161602180300 Smallpox Booster 2 Age 4 N/A
PX161602_Smallpox_Booster_2_Date_Day PX161602180402 Smallpox Booster 2 Date - Day 4 N/A
PX161602_Smallpox_Booster_2_Date_Month PX161602180401 Smallpox Booster 2 Date - Month 4 N/A
PX161602_Smallpox_Booster_2_Date_Year PX161602180403 Smallpox Booster 2 Date - Year 4 N/A
PX161602_Smallpox_Booster_3_Age PX161602180500 Smallpox Booster 3 Age 4 N/A
PX161602_Smallpox_Booster_3_Date_Day PX161602180602 Smallpox Booster 3 Date - Day 4 N/A
PX161602_Smallpox_Booster_3_Date_Month PX161602180601 Smallpox Booster 3 Date - Month 4 N/A
PX161602_Smallpox_Booster_3_Date_Year PX161602180603 Smallpox Booster 3 Date - Year 4 N/A
PX161602_StomachLiverIntestinal_Date_Of_Onset_Day PX161602013502 Stomach Liver or Intestinal Problems Date of Onset - Day 4 N/A
PX161602_StomachLiverIntestinal_Date_Of_Onset_Month PX161602013501 Stomach Liver or Intestinal Problems Date of Onset - Month 4 N/A
PX161602_StomachLiverIntestinal_Date_Of_Onset_Year PX161602013503 Stomach Liver or Intestinal Problems Date of Onset - Year 4 N/A
PX161602_Stomach_Liver_Problems PX161602013500 Stomach or Liver Problems 4 N/A
PX161602_Surgery_1_Comments PX161602450700 Surgery 1 - Comments 4 N/A
PX161602_Surgery_1_Date_Day PX161602450101 Surgery 1 - Date - Day 4 N/A
PX161602_Surgery_1_Date_Month PX161602450102 Surgery 1 - Date - Month 4 N/A
PX161602_Surgery_1_Date_Year PX161602450103 Surgery 1 - Date - Year 4 N/A
PX161602_Surgery_1_Description PX161602450500 Surgery 1 - Description 4 N/A
PX161602_Surgery_1_Doctor PX161602450200 Surgery 1 - Doctor 4 N/A
PX161602_Surgery_1_Hospital PX161602450300 Surgery 1 - Hospital 4 N/A
PX161602_Surgery_1_Results PX161602450600 Surgery 1 - Results 4 N/A
PX161602_Surgery_1_Surgical_Procedure PX161602450400 Surgery 1 - Surgical Procedure 4 N/A
PX161602_Surgery_2_Comments PX161602460700 Surgery 2 - Comments 4 N/A
PX161602_Surgery_2_Date_Day PX161602460101 Surgery 2 - Date - Day 4 N/A
PX161602_Surgery_2_Date_Month PX161602460102 Surgery 2 - Date - Month 4 N/A
PX161602_Surgery_2_Date_Year PX161602460103 Surgery 2 - Date - Year 4 N/A
PX161602_Surgery_2_Description PX161602460500 Surgery 2 - Description 4 N/A
PX161602_Surgery_2_Doctor PX161602460200 Surgery 2 - Doctor 4 N/A
PX161602_Surgery_2_Hospital PX161602460300 Surgery 2 - Hospital 4 N/A
PX161602_Surgery_2_Results PX161602460600 Surgery 2 - Results 4 N/A
PX161602_Surgery_2_Surgical_Procedure PX161602460400 Surgery 2 - Surgical Procedure 4 N/A
PX161602_Surgery_3_Comments PX161602470700 Surgery 3 - Comments 4 N/A
PX161602_Surgery_3_Date_Day PX161602470101 Surgery 3 - Date - Day 4 N/A
PX161602_Surgery_3_Date_Month PX161602470102 Surgery 3 - Date - Month 4 N/A
PX161602_Surgery_3_Date_Year PX161602470103 Surgery 3 - Date - Year 4 N/A
PX161602_Surgery_3_Description PX161602470500 Surgery 3 - Description 4 N/A
PX161602_Surgery_3_Doctor PX161602470200 Surgery 3 - Doctor 4 N/A
PX161602_Surgery_3_Hospital PX161602470300 Surgery 3 - Hospital 4 N/A
PX161602_Surgery_3_Results PX161602470600 Surgery 3 - Results 4 N/A
PX161602_Surgery_3_Surgical_Procedure PX161602470400 Surgery 3 - Surgical Procedure 4 N/A
PX161602_Syphilis PX161602013600 Syphilis 4 N/A
PX161602_Syphilis_Date_Of_Onset_Day PX161602013602 Syphilis Date of Onset - Day 4 N/A
PX161602_Syphilis_Date_Of_Onset_Month PX161602013601 Syphilis Date of Onset - Month 4 N/A
PX161602_Syphilis_Date_Of_Onset_Year PX161602013603 Syphilis Date of Onset - Year 4 N/A
PX161602_Tetanus_Booster_1_Age PX161602190100 Tetanus Booster 1 Age 4 N/A
PX161602_Tetanus_Booster_1_Date_Day PX161602190202 Tetanus Booster 1 Date - Day 4 N/A
PX161602_Tetanus_Booster_1_Date_Month PX161602190201 Tetanus Booster 1 Date - Month 4 N/A
PX161602_Tetanus_Booster_1_Date_Year PX161602190203 Tetanus Booster 1 Date - Year 4 N/A
PX161602_Tetanus_Booster_2_Age PX161602190300 Tetanus Booster 2 Age 4 N/A
PX161602_Tetanus_Booster_2_Date_Day PX161602190402 Tetanus Booster 2 Date - Day 4 N/A
PX161602_Tetanus_Booster_2_Date_Month PX161602190401 Tetanus Booster 2 Date - Month 4 N/A
PX161602_Tetanus_Booster_2_Date_Year PX161602190403 Tetanus Booster 2 Date - Year 4 N/A
PX161602_Tetanus_Booster_3_Age PX161602190500 Tetanus Booster 3 Age 4 N/A
PX161602_Tetanus_Booster_3_Date_Day PX161602190602 Tetanus Booster 3 Date - Day 4 N/A
PX161602_Tetanus_Booster_3_Date_Month PX161602190601 Tetanus Booster 3 Date - Month 4 N/A
PX161602_Tetanus_Booster_3_Date_Year PX161602190603 Tetanus Booster 3 Date - Year 4 N/A
PX161602_Thyroid_Date_Of_Onset_Day PX161602013902 Thyroid Problems Date of Onset - Day 4 N/A
PX161602_Thyroid_Date_Of_Onset_Month PX161602013901 Thyroid Problems Date of Onset - Month 4 N/A
PX161602_Thyroid_Date_Of_Onset_Year PX161602013903 Thyroid Problems Date of Onset - Year 4 N/A
PX161602_Thyroid_Problems PX161602013900 Thyroid Problems 4 N/A
PX161602_Tuberculosis PX161602013700 Tuberculosis 4 N/A
PX161602_Tuberculosis_Booster_1_Age PX161602200100 Tuberculosis Booster 1 Age 4 N/A
PX161602_Tuberculosis_Booster_1_Date_Day PX161602200202 Tuberculosis Booster 1 Date - Day 4 N/A
PX161602_Tuberculosis_Booster_1_Date_Month PX161602200201 Tuberculosis Booster 1 Date - Month 4 N/A
PX161602_Tuberculosis_Booster_1_Date_Year PX161602200203 Tuberculosis Booster 1 Date - Year 4 N/A
PX161602_Tuberculosis_Booster_2_Age PX161602200300 Tuberculosis Booster 2 Age 4 N/A
PX161602_Tuberculosis_Booster_2_Date_Day PX161602200402 Tuberculosis Booster 2 Date - Day 4 N/A
PX161602_Tuberculosis_Booster_2_Date_Month PX161602200401 Tuberculosis Booster 2 Date - Month 4 N/A
PX161602_Tuberculosis_Booster_2_Date_Year PX161602200403 Tuberculosis Booster 2 Date - Year 4 N/A
PX161602_Tuberculosis_Booster_3_Age PX161602200500 Tuberculosis Booster 3 Age 4 N/A
PX161602_Tuberculosis_Booster_3_Date_Day PX161602200602 Tuberculosis Booster 3 Date - Day 4 N/A
PX161602_Tuberculosis_Booster_3_Date_Month PX161602200601 Tuberculosis Booster 3 Date - Month 4 N/A
PX161602_Tuberculosis_Booster_3_Date_Year PX161602200603 Tuberculosis Booster 3 Date - Year 4 N/A
PX161602_Tuberculosis_Date_Of_OnsetDay PX161602013702 Tuberculosis Date of Onset-Day 4 N/A
PX161602_Tuberculosis_Date_Of_OnsetMonth PX161602013701 Tuberculosis Date of Onset-Month 4 N/A
PX161602_Tuberculosis_Date_Of_OnsetYear PX161602013703 Tuberculosis Date of Onset-Year 4 N/A
PX161602_Tumor PX161602013800 Tumor 4 N/A
PX161602_Tumor_Date_Of_Onset_Day PX161602013802 Tumor Date of Onset - Day 4 N/A
PX161602_Tumor_Date_Of_Onset_Month PX161602013801 Tumor Date of Onset - Month 4 N/A
PX161602_Tumor_Date_Of_Onset_Year PX161602013803 Tumor Date of Onset - Year 4 N/A
PX161602_Typhoid_Booster_1_Age PX161602210100 Typhoid Booster 1 Age 4 N/A
PX161602_Typhoid_Booster_1_Date_Day PX161602210202 Typhoid Booster 1 Date - Day 4 N/A
PX161602_Typhoid_Booster_1_Date_Month PX161602210201 Typhoid Booster 1 Date - Month 4 N/A
PX161602_Typhoid_Booster_1_Date_Year PX161602210203 Typhoid Booster 1 Date - Year 4 N/A
PX161602_Typhoid_Booster_2_Age PX161602210300 Typhoid Booster 2 Age 4 N/A
PX161602_Typhoid_Booster_2_Date_Day PX161602210402 Typhoid Booster 2 Date - Day 4 N/A
PX161602_Typhoid_Booster_2_Date_Month PX161602210401 Typhoid Booster 2 Date - Month 4 N/A
PX161602_Typhoid_Booster_2_Date_Year PX161602210403 Typhoid Booster 2 Date - Year 4 N/A
PX161602_Typhoid_Booster_3_Age PX161602210500 Typhoid Booster 3 Age 4 N/A
PX161602_Typhoid_Booster_3_Date_Day PX161602210602 Typhoid Booster 3 Date - Day 4 N/A
PX161602_Typhoid_Booster_3_Date_Month PX161602210601 Typhoid Booster 3 Date - Month 4 N/A
PX161602_Typhoid_Booster_3_Date_Year PX161602210603 Typhoid Booster 3 Date - Year 4 N/A
PX161602_Unconsciousness_Date_Of_Onset_Day PX161602013002 Periods of Unconsciousness Date of Onset - Day 4 N/A
PX161602_Unconsciousness_Date_Of_Onset_Month PX161602013001 Periods of Unconsciousness Date of Onset - Month 4 N/A
PX161602_Unconsciousness_Date_Of_Onset_Year PX161602013003 Periods of Unconsciousness Date of Onset - Year 4 N/A
PX161602_UrinaryTractInfection_Date_Of_Onset_Day PX161602014002 Urinary Tract Infection Date of Onset - Day 4 N/A
PX161602_UrinaryTractInfection_Date_Of_Onset_Month PX161602014001 Urinary Tract Infection Date of Onset - Month 4 N/A
PX161602_UrinaryTractInfection_Date_Of_Onset_Year PX161602014003 Urinary Tract Infection Date of Onset - Year 4 N/A
PX161602_Urinary_Tract_Problems PX161602014000 Urinary Tract Problems 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