iPHIS character limit: 50 asked No Yes 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 Yes If yes, Name of hospital: room? No Date(s): ♦ Yes If yes, Name of hospital: Were you admitted to ♦ hospital as a result of your No Date of admission: illness (not including stay in Don’t recall Date of discharge: the emergency room)? Unknown discharge date → For iPHIS 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 Route of administration: Dosage: Did you take Yes medication? No Don’t recall Treatment information can be entered in iPHIS under Cases > Case > Rx/Treatments>Treatment as per current iPHIS User Guide Date of Onset, Age and Gender Complete this section if submission of pages 6-8 and 13-14 to Public Health Ontario is required Date of Onset: Age: Gender: Response Details
iPHIS character limit: 50 Yes No Unknown Not asked 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 iPHIS 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: Route 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 Date of Onset, Age and Gender Complete this section if submission of pages 6-8 and 13-14 to Public Health Ontario is required Date of Onset: Age: Gender: Response Details
Food%20Poisoning%20Investigation%20Tool.docx