CDEs
Forms
History of Previous Travel - Country 1 - Check if travelled to country five years ago.
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days this year
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days last year
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days two years ago
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days three years ago
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days four years ago
History of Previous Travel - Country 1 - Stay was longer than 30 consecutive days five years ago
Country of Exposure/Other
Country exposure sequence PhenX
More Specific Place of Exposure
Reason for Travel Related to Current Illness (Check One)
Risk Level Qualifier (Check One)
Clinical Setting (Check One)
Patient Type (Check One)
Did the patient have a pre-travel encounter with a health care provider [PhenX]
Abnormal lab test PhenX
Asymptomatic screening PhenX
Main presenting symptom PhenX
Main Presenting Symptoms If "Other," Specify:
Working Dx number PhenX
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