Job-related hazard exposures (such as Occupational  radiation, chemicals, X Health History biologicals) or injuries/illnesses  Allergy List Allergies and sensitivities X Problems/ Listing of Reported Medical  X Diagnoses List Problems Diet/exercise habits, Risk Caffeine, Tobacco, &  Factors/Lifestyle X Alcohol use, Sun exposure, Questionnaire Framingham Risk Score Exams performed as part of Selection / astronaut selection, FAA  Qualifying X certificate status, Diver Information certification Records of medications and usage. Data such as Medication and medication, dose, Supplement  frequency, effectiveness X X X X recommendations may exist in the EMR or and inflight medical records (PMC, medication kits, flight surgeon logs, etc.) Records from consultants or external medical Consultant providers from outside  X X X Records NASA (such as orthopedics, cardiology, neurology, ophthalmology) Clinical Data Derived from Medication logs, diagnoses  X Private Medical (e.g. headache), etc. Conferences / Type of Typical Variables / Data Justification for Use of Data Assessments Other Annual Preflight In-flight Postflight Comments regarding inflight Postflight Medical medical events, fluid  X Debriefs loading, noise, sleep, issues, etc.
 Occupational Health History Job-related hazard exposures (such as radiation, chemicals, biologicals) or injuries/illnesses X  Allergy List Allergies and sensitivities X  Problems/ Diagnoses List Listing of Reported Medical Problems X  Risk Factors/Lifestyle Questionnaire Diet/exercise habits, Caffeine, Tobacco, & Alcohol use, Sun exposure, Framingham Risk Score X  Selection / Qualifying Information Exams performed as part of astronaut selection, FAA certificate status, Diver certification X  Medication and Supplement recommendations and Records of medications and usage. Data such as medication, dose, frequency, effectiveness may exist in the EMR or inflight medical records (PMC, medication kits, flight surgeon logs, etc.) X X X X  Consultant Records Records from consultants or external medical providers from outside NASA (such as orthopedics, cardiology, neurology, ophthalmology) X X X  Clinical Data Derived from Private Medical Conferences Medication logs, diagnoses (e.g. headache), etc. X Type of Assessments Typical Variables / Data Preflight In-flight Postflight Annual / Other Justification for Use of Data  Postflight Medical Debriefs Comments regarding inflight medical events, fluid loading, noise, sleep, issues, etc. X
hrpretrospectivedatarequestform_final.docx