Unimmunized (against Typhoid Fever) 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 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 5-7 and 12-13 to Public Health Ontario is required Date of Onset: Age: Gender: Response Details Preliminary Questions No Yes Unsure Do you have any idea how you became sick? Were you on any specific diet(s) in the 3-60 days prior to the onset of your illness (e.g., vegetarian, vegan, gluten-free, kosher, halal, etc.)? Chronic carriers can harbor the S. Typhi bacteria unknowingly for
Unimmunized (against Typhoid Fever) 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 5-7 and 12-13 to Public Health Ontario is required Date of Onset: Age: Gender: Preliminary Questions Response Details Yes No Unsure Do you have any idea how you became sick? Were you on any specific diet(s) in the 3-60 days prior to the onset of your illness (e.g., vegetarian, vegan, gluten-free, kosher, halal, etc.)? Chronic carriers can harbor the S. Typhi bacteria unknowingly for
Typhoid%20Fever%20Investigation%20Tool.docx