Details Medical Risk Factors iPHIS character limit: 50 No Yes Not Unknown Immunocompromised (specify) (e.g., by medication or by disease such as cancer, diabetes, etc.) Other (specify) (e.g., use of antacid, surgery, etc.) Unknown For iPHIS data entry check Yes for Unknown if all other Medical Risk → – Factors are No or Unknown. Hospitalization & Treatment Mandatory in iPHIS only if admitted to hospital Did you go to an emergency Yes If yes, Name of hospital: room? No Date(s): Yes If yes, Name of hospital: ♦ Were you admitted to No hospital as a result of your ♦ Date of admission: illness (not including stay in Don’t recall Date of discharge: the emergency room)? Unknown discharge date For data entry if the case is hospitalized enter information under Interventions. → – Were you prescribed Yes If yes, Medication: antibiotics or medication No Start date: End date: for your illness? Don’t recall of administration: Dosage: Did you take Yes counter medication? No Don’t recall Treatment information can be entered in iPHIS under Cases > Case > Rx/Treatments>Treatment as per current iPHIS User Guide NOTE TO INVESTIGATORS S. dysenteriae cases should be interviewed based on a 7 day period. Date of Onset, Age and Gender Complete this section if submission of pages 5-8, 13- 14 to Public Health Ontario is required
Medical Risk Factors Details iPHIS character limit: 50 Yes No Unknown Not Immunocompromised (specify) (e.g., by medication or by disease such as cancer, diabetes, etc.) Other (specify) (e.g., use of antacid, surgery, etc.) Unknown → For iPHIS data entry – check Yes for Unknown if all other Medical Risk Factors are No or Unknown. Hospitalization & Treatment Mandatory in iPHIS only if admitted to hospital Did you go to an emergency room? Yes No If yes, Name of hospital: Date(s): ♦ Were you admitted to hospital as a result of your illness (not including stay in the emergency room)? Yes No Don’t recall If yes, Name of hospital: ♦ Date of admission: Date of discharge: Unknown discharge date → For data entry – if the case is hospitalized enter information under Interventions. Were you prescribed antibiotics or medication for your illness? Yes No Don’t recall If yes, Medication: Start date: End date: of administration: Dosage: Did you take medication? Yes No Don’t recall Treatment information can be entered in iPHIS under Cases > Case > Rx/Treatments>Treatment as per current iPHIS User Guide NOTE TO INVESTIGATORS S. dysenteriae cases should be interviewed based on a 7 day period. Date of Onset, Age and Gender Complete this section if submission of pages 5-8, 13- 14 to Public Health Ontario is required counter