- 25 days - 3 days Onset Medical Risk Factors Response Details 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 ♦ 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 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 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
- 25 days - 3 days Onset Medical Risk Factors 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 counter
Giardiasis%20Investigation%20Tool.docx