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Protocol - Personal Medical History of Allergies, Infectious Diseases, and Immunizations - Child

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Protocol Name from Source:

The Expert Review Panel has not reviewed this measure yet.

Availability:

Publicly available

Description:

This protocol is a proxy-administered personal health record from the American Health Information Management Association (AHIMA). The parent or guardian is asked to provide details on the child in the following categories: Birth, Health Log, Allergies/Drug Sensitivities, Infectious Disease, and Immunizations.

Protocol:

A. Birth

Hospital


Height


Length


Doctor


Prenatal Problem


Apgar Score


B. Health Log

Date

Health Problem

Remarks
(e.g., medications, special tests, x-rays, length of hospital stay, surgery)

 

 

 

 

 

 

 

 

 

C. Allergies/Drug Sensitivities

Allergy/Sensitivity Type
(include medications, foods, environmental, or other)

Reaction

Date Last Occurred

Treatment

 

 

 

 

 

 

 

 

 

 

 

 

D. Infectious Disease

Disease

Age

Date

Remarks

Chicken Pox

     

Measles

     

Rubella

     

Hepatitis

     

Pertussis/Whooping Cough

     

Pneumonia

     

Polio

     

Mumps

     

Scarlet Fever

     

Other

     

E. Immunizations

  BOOSTER 1 BOOSTER 2 BOOSTER 3

Immunizations

AGE

DATE

AGE

DATE

AGE

DATE

Diphtheria

           

Pertussis/Whooping Cough

           

Tetanus

           

Smallpox

           

Typhoid

           

Rubella

           

Mumps

           

Measles

           

Tuberculosis

           

Hepatitis B

           

Other

           

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Interviewer (face-to-face)

Life Stage:

Infant, Child, Adolescent

Specific Instructions:

None

Research Domain Information

Release Date:

November 12, 2010

Definition

This measure is a questionnaire to collect information on a participant's personal medical history of allergies, infectious diseases, and immunizations.

Purpose

This measure can be used to establish a respondent's medical history of allergies, selected infectious diseases, and immunizations.

Selection Rationale

The American Health Information Management Association's (AHIMA's) My Personal Health Record (MyPHR) protocol is a national program used by several state health information management associations in community-based settings.

Language

English, Spanish

Standards

StandardNameIDSource
Common Data Elements (CDE)Child Hypersensitivity Personal Medical History Assessment Description Text3151231CDE Browser
Common Data Elements (CDE)Child Immunization Personal Medical History Assessment Description Text3151223CDE Browser
Common Data Elements (CDE)Child Infectious Disorder Personal Medical History Assessment Description Text3151230CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Hx allerg infect immun child proto62894-1LOINC

Process and Review

The Expert Review Panel has not reviewed this measure yet.

Source

American Health Information Management Association (AHIMA). My Personal Health Record (MyPHR). Child PHR Form 2006. Sections B,C, D, F, G.

General References

None

Protocol ID:

161601

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX161601_Birth_HospitalPX161601010100Birth Hospital4N/A
PX161601_Birth_WeightPX161601010200Birth Weight4N/A
PX161601_Birth_Weight_UnitsPX161601010201Birth Weight - Specify Units4N/A
PX161601_Birth_LengthPX161601010300Birth Length4N/A
PX161601_Birth_Length_UnitsPX161601010301Birth Length - Specify units4N/A
PX161601_Birth_DoctorPX161601010400Birth Doctor4N/A
PX161601_Birth_Prenatal_ProblemPX161601010500Birth Prenatal Problem4N/A
PX161601_Birth_Apgar_ScorePX161601010600Birth Apgar Score4N/A
PX161601_Health_Problem1_TypePX161601020101Health Problem 1 - Type4N/A
PX161601_Health_Problem1_Date_MonthPX161601020102Health Problem 1 - Date - Month4N/A
PX161601_Health_Problem1_Date_DayPX161601020103Health Problem 1 - Date - Day4N/A
PX161601_Health_Problem1_Date_YearPX161601020104Health Problem 1 - Date - Year4N/A
PX161601_Health_Problem1_RemarksPX161601020105Health Problem 1 - Remarks (e.g., medications, special tests, x-rays, length of hospital stay, surgery)4N/A
PX161601_Health_Problem2_TypePX161601020201Health Problem 2 - Type4N/A
PX161601_Health_Problem2_Date_MonthPX161601020202Health Problem 2 - Date - Month4N/A
PX161601_Health_Problem2_Date_DayPX161601020203Health Problem 2 - Date - Day4N/A
PX161601_Health_Problem2_Date_YearPX161601020204Health Problem 2 - Date - Year4N/A
PX161601_Health_Problem2_RemarksPX161601020205Health Problem 2 - Remarks (e.g., medications, special tests, x-rays, length of hospital stay, surgery)4N/A
PX161601_Health_Problem3_TypePX161601020301Health Problem 3 - Type4N/A
PX161601_Health_Problem3_Date_MonthPX161601020302Health Problem 3 - Date - Month4N/A
PX161601_Health_Problem3_Date_DayPX161601020303Health Problem 3 - Date - Day4N/A
PX161601_Health_Problem3_Date_YearPX161601020304Health Problem 3 - Date - Year4N/A
PX161601_Health_Problem3_RemarksPX161601020305Health Problem 3 - Remarks (e.g., medications, special tests, x-rays, length of hospital stay, surgery)4N/A
PX161601_Allergy/Sensitivity1_TypePX161601030101Allergy/Sensitivity 1 - Type (include medications, foods, environmental, or other)4N/A
PX161601_Allergy/Sensitivity1_ReactionPX161601030102Allergy/Sensitivity 1 - Reaction4N/A
PX161601_Allergy/Sensitivity1_Date_Last_Occurred_MonthPX161601030103Allergy/Sensitivity 1 - Date Last Occurred - Month4N/A
PX161601_Allergy/Sensitivity1_Date_Last_Occurred_DayPX161601030104Allergy/Sensitivity 1 - Date Last Occurred - Day4N/A
PX161601_Allergy/Sensitivity1_Date_Last_Occurred_YearPX161601030105Allergy/Sensitivity 1 - Date Last Occurred - Year4N/A
PX161601_Allergy/Sensitivity1_TreatmentPX161601030106Allergy/Sensitivity 1 - Treatment4N/A
PX161601_Allergy/Sensitivity2_TypePX161601030201Allergy/Sensitivity 2 - Type (include medications, foods, environmental, or other)4N/A
PX161601_Allergy/Sensitivity2_ReactionPX161601030202Allergy/Sensitivity 2 - Reaction4N/A
PX161601_Allergy/Sensitivity2_Date_Last_Occurred_MonthPX161601030203Allergy/Sensitivity 2 - Date Last Occurred - Month4N/A
PX161601_Allergy/Sensitivity2_Date_Last_Occurred_DayPX161601030204Allergy/Sensitivity 2 - Date Last Occurred - Day4N/A
PX161601_Allergy/Sensitivity2_Date_Last_Occurred_YearPX161601030205Allergy/Sensitivity 2 - Date Last Occurred - Year4N/A
PX161601_Allergy/Sensitivity2_TreatmentPX161601030206Allergy/Sensitivity 2 - Treatment4N/A
PX161601_Allergy/Sensitivity3_TypePX161601030301Allergy/Sensitivity 3 - Type (include medications, foods, environmental, or other)4N/A
PX161601_Allergy/Sensitivity3_ReactionPX161601030302Allergy/Sensitivity 3 - Reaction4N/A
PX161601_Allergy/Sensitivity3_Date_Last_Occurred_MonthPX161601030303Allergy/Sensitivity 3 - Date Last Occurred - Month4N/A
PX161601_Allergy/Sensitivity3_Date_Last_Occurred_DayPX161601030304Allergy/Sensitivity 3 - Date Last Occurred - Day4N/A
PX161601_Allergy/Sensitivity3_Date_Last_Occurred_YearPX161601030305Allergy/Sensitivity 3 - Date Last Occurred - Year4N/A
PX161601_Allergy/Sensitivity3_TreatmentPX161601030306Allergy/Sensitivity 3 - Treatment4N/A
PX161601_Chicken_Pox_AgePX161601040101Chicken Pox - Age4N/A
PX161601_Chicken_Pox_Date_MonthPX161601040102Chicken Pox - Date - Month4N/A
PX161601_Chicken_Pox_Date_DayPX161601040103Chicken Pox - Date - Day4N/A
PX161601_Chicken_Pox_Date_YearPX161601040104Chicken Pox - Date - Year4N/A
PX161601_Chicken_Pox_RemarksPX161601040105Chicken Pox - Remarks4N/A
PX161601_Measles_AgePX161601040201Measles - Age4N/A
PX161601_Measles_Date_MonthPX161601040202Measles - Date - Month4N/A
PX161601_Measles_Date_DayPX161601040203Measles - Date - Day4N/A
PX161601_Measles_Date_YearPX161601040204Measles - Date - Year4N/A
PX161601_Measles_RemarksPX161601040205Measles - Remarks4N/A
PX161601_Rubella_AgePX161601040301Rubella - Age4N/A
PX161601_Rubella_Date_MonthPX161601040302Rubella - Date - Month4N/A
PX161601_Rubella_Date_DayPX161601040303Rubella - Date - Day4N/A
PX161601_Rubella_Date_YearPX161601040304Rubella - Date - Year4N/A
PX161601_Rubella_RemarksPX161601040305Rubella - Remarks4N/A
PX161601_Hepatitis_AgePX161601040401Hepatitis - Age4N/A
PX161601_Hepatitis_Date_MonthPX161601040402Hepatitis - Date - Month4N/A
PX161601_Hepatitis_Date_DayPX161601040403Hepatitis - Date - Day4N/A
PX161601_Hepatitis_Date_YearPX161601040404Hepatitis - Date - Year4N/A
PX161601_Hepatitis_RemarksPX161601040405Hepatitis - Remarks4N/A
PX161601_Pertussis/Whooping_Cough_AgePX161601040501Pertussis/Whooping Cough - Age4N/A
PX161601_Pertussis/Whooping_Cough_Date_MonthPX161601040502Pertussis/Whooping Cough - Date - Month4N/A
PX161601_Pertussis/Whooping_Cough_Date_DayPX161601040503Pertussis/Whooping Cough - Date - Day4N/A
PX161601_Pertussis/Whooping_Cough_Date_YearPX161601040504Pertussis/Whooping Cough - Date - Year4N/A
PX161601_Pertussis/Whooping_Cough_RemarksPX161601040505Pertussis/Whooping Cough - Remarks4N/A
PX161601_Pneumonia_AgePX161601040601Pneumonia - Age4N/A
PX161601_Pneumonia_Date_MonthPX161601040602Pneumonia - Date - Month4N/A
PX161601_Pneumonia_Date_DayPX161601040603Pneumonia - Date - Day4N/A
PX161601_Pneumonia_Date_YearPX161601040604Pneumonia - Date - Year4N/A
PX161601_Pneumonia_RemarksPX161601040605Pneumonia - Remarks4N/A
PX161601_Polio_AgePX161601040701Polio - Age4N/A
PX161601_Polio_Date_MonthPX161601040702Polio - Date - Month4N/A
PX161601_Polio_Date_DayPX161601040703Polio - Date - Day4N/A
PX161601_Polio_Date_YearPX161601040704Polio - Date - Year4N/A
PX161601_Polio_RemarksPX161601040705Polio - Remarks4N/A
PX161601_Mumps_AgePX161601040801Mumps - Age4N/A
PX161601_Mumps_Date_MonthPX161601040802Mumps - Date - Month4N/A
PX161601_Mumps_Date_DayPX161601040803Mumps - Date - Day4N/A
PX161601_Mumps_Date_YearPX161601040804Mumps - Date - Year4N/A
PX161601_Mumps_RemarksPX161601040805Mumps - Remarks4N/A
PX161601_Scarlet_Fever_AgePX161601040901Scarlet Fever - Age4N/A
PX161601_Scarlet_Fever_Date_MonthPX161601040902Scarlet Fever - Date - Month4N/A
PX161601_Scarlet_Fever_Date_DayPX161601040903Scarlet Fever - Date - Day4N/A
PX161601_Scarlet_Fever_Date_YearPX161601040904Scarlet Fever - Date - Year4N/A
PX161601_Scarlet_Fever_RemarksPX161601040905Scarlet Fever - Remarks4N/A
PX161601_Other_AgePX161601041001Other - Age4N/A
PX161601_Other_Date_MonthPX161601041002Other - Date - Month4N/A
PX161601_Other_Date_DayPX161601041003Other - Date - Day4N/A
PX161601_Other_Date_YearPX161601041004Other - Date - Year4N/A
PX161601_Other_RemarksPX161601041005Other - Remarks4N/A
PX161601_Diphtheria_Booster1_AgePX161601050100Diphtheria Booster 1 Age4N/A
PX161601_Diphtheria_Booster1_Date_MonthPX161601050201Diphtheria Booster 1 Date - Month4N/A
PX161601_Diphtheria_Booster1_Date_DayPX161601050202Diphtheria Booster 1 Date - Day4N/A
PX161601_Diphtheria_Booster1_Date_YearPX161601050203Diphtheria Booster 1 Date - Year4N/A
PX161601_Diphtheria_Booster2_AgePX161601050300Diphtheria Booster 2 Age4N/A
PX161601_Diphtheria_Booster2_Date_MonthPX161601050401Diphtheria Booster 2 Date - Month4N/A
PX161601_Diphtheria_Booster2_Date_DayPX161601050402Diphtheria Booster 2 Date - Day4N/A
PX161601_Diphtheria_Booster2_Date_YearPX161601050403Diphtheria Booster 2 Date - Year4N/A
PX161601_Diphtheria_Booster3_AgePX161601050500Diphtheria Booster 3 Age4N/A
PX161601_Diphtheria_Booster3_Date_MonthPX161601050601Diphtheria Booster 3 Date - Month4N/A
PX161601_Diphtheria_Booster3_Date_DayPX161601050602Diphtheria Booster 3 Date - Day4N/A
PX161601_Diphtheria_Booster3_Date_YearPX161601050603Diphtheria Booster 3 Date - Year4N/A
PX161601_Pertussis/Whooping_Cough_Booster1_AgePX161601060100Pertussis/Whooping Cough Booster 1 Age4N/A
PX161601_Pertussis/Whooping_Cough_Booster1_Date_MonthPX161601060201Pertussis/Whooping Cough Booster 1 Date - Month4N/A
PX161601_Pertussis/Whooping_Cough_Booster1_Date_DayPX161601060202Pertussis/Whooping Cough Booster 1 Date - Day4N/A
PX161601_Pertussis/Whooping_Cough_Booster1_Date_YearPX161601060203Pertussis/Whooping Cough Booster 1 Date - Year4N/A
PX161601_Pertussis/Whooping_Cough_Booster2_AgePX161601060300Pertussis/Whooping Cough Booster 2 Age4N/A
PX161601_Pertussis/Whooping_Cough_Booster2_Date_MonthPX161601060401Pertussis/Whooping Cough Booster 2 Date - Month4N/A
PX161601_Pertussis/Whooping_Cough_Booster2_Date_DayPX161601060402Pertussis/Whooping Cough Booster 2 Date - Day4N/A
PX161601_Pertussis/Whooping_Cough_Booster2_Date_YearPX161601060403Pertussis/Whooping Cough Booster 2 Date - Year4N/A
PX161601_Pertussis/Whooping_Cough_Booster3_AgePX161601060500Pertussis/Whooping Cough Booster 3 Age4N/A
PX161601_Pertussis/Whooping_Cough_Booster3_Date_MonthPX161601060601Pertussis/Whooping Cough Booster 3 Date - Month4N/A
PX161601_Pertussis/Whooping_Cough_Booster3_Date_DayPX161601060602Pertussis/Whooping Cough Booster 3 Date - Day4N/A
PX161601_Pertussis/Whooping_Cough_Booster3_Date_YearPX161601060603Pertussis/Whooping Cough Booster 3 Date - Year4N/A
PX161601_Tetanus_Booster1_AgePX161601070100Tetanus Booster 1 Age4N/A
PX161601_Tetanus_Booster1_Date_MonthPX161601070201Tetanus Booster 1 Date - Month4N/A
PX161601_Tetanus_Booster1_Date_DayPX161601070202Tetanus Booster 1 Date - Day4N/A
PX161601_Tetanus_Booster2_AgePX161601070300Tetanus Booster 2 Age4N/A
PX161601_Tetanus_Booster2_Date_MonthPX161601070401Tetanus Booster 2 Date - Month4N/A
PX161601_Tetanus_Booster2_Date_DayPX161601070402Tetanus Booster 2 Date - Day4N/A
PX161601_Tetanus_Booster2_Date_YearPX161601070403Tetanus Booster 2 Date - Year4N/A
PX161601_Tetanus_Booster3_AgePX161601070500Tetanus Booster 3 Age4N/A
PX161601_Tetanus_Booster3_Date_MonthPX161601070601Tetanus Booster 3 Date - Month4N/A
PX161601_Tetanus_Booster3_Date_DayPX161601070602Tetanus Booster 3 Date - Day4N/A
PX161601_Tetanus_Booster3_Date_YearPX161601070603Tetanus Booster 3 Date - Year4N/A
PX161601_Smallpox_Booster1_AgePX161601080100Smallpox Booster 1 Age4N/A
PX161601_Smallpox_Booster1_Date_MonthPX161601080201Smallpox Booster 1 Date - Month4N/A
PX161601_Smallpox_Booster1_Date_DayPX161601080202Smallpox Booster 1 Date - Day4N/A
PX161601_Smallpox_Booster1_Date_YearPX161601080203Smallpox Booster 1 Date - Year4N/A
PX161601_Smallpox_Booster2_AgePX161601080300Smallpox Booster 2 Age4N/A
PX161601_Smallpox_Booster2_Date_MonthPX161601080401Smallpox Booster 2 Date - Month4N/A
PX161601_Smallpox_Booster2_Date_DayPX161601080402Smallpox Booster 2 Date - Day4N/A
PX161601_Smallpox_Booster2_Date_YearPX161601080403Smallpox Booster 2 Date - Year4N/A
PX161601_Smallpox_Booster3_AgePX161601080500Smallpox Booster 3 Age4N/A
PX161601_Smallpox_Booster3_Date_MonthPX161601080601Smallpox Booster 3 Date - Month4N/A
PX161601_Smallpox_Booster3_Date_DayPX161601080602Smallpox Booster 3 Date - Day4N/A
PX161601_Smallpox_Booster3_Date_YearPX161601080603Smallpox Booster 3 Date - Year4N/A
PX161601_Typhoid_Booster1_AgePX161601090100Typhoid Booster 1 Age4N/A
PX161601_Tetanus_Booster1_Date_YearPX161601070203Tetanus Booster 1 Date - Year4N/A
PX161601_Typhoid_Booster1_Date_MonthPX161601090201Typhoid Booster 1 Date - Month4N/A
PX161601_Typhoid_Booster1_Date_DayPX161601090202Typhoid Booster 1 Date - Day4N/A
PX161601_Typhoid_Booster1_Date_YearPX161601090203Typhoid Booster 1 Date - Year4N/A
PX161601_Typhoid_Booster2_AgePX161601090300Typhoid Booster 2 Age4N/A
PX161601_Typhoid_Booster2_Date_MonthPX161601090401Typhoid Booster 2 Date - Month4N/A
PX161601_Typhoid_Booster2_Date_DayPX161601090402Typhoid Booster 2 Date - Day4N/A
PX161601_Typhoid_Booster2_Date_YearPX161601090403Typhoid Booster 2 Date - Year4N/A
PX161601_Typhoid_Booster3_AgePX161601090500Typhoid Booster 3 Age4N/A
PX161601_Typhoid_Booster3_Date_MonthPX161601090601Typhoid Booster 3 Date - Month4N/A
PX161601_Typhoid_Booster3_Date_DayPX161601090602Typhoid Booster 3 Date - Day4N/A
PX161601_Typhoid_Booster3_Date_YearPX161601090603Typhoid Booster 3 Date - Year4N/A
PX161601_Rubella_Booster1_AgePX161601100100Rubella Booster 1 Age4N/A
PX161601_Rubella_Booster1_Date_MonthPX161601100201Rubella Booster 1 Date - Month4N/A
PX161601_Rubella_Booster1_Date_DayPX161601100202Rubella Booster 1 Date - Day4N/A
PX161601_Rubella_Booster1_Date_YearPX161601100203Rubella Booster 1 Date - Year4N/A
PX161601_Rubella_Booster2_AgePX161601100300Rubella Booster 2 Age4N/A
PX161601_Rubella_Booster2_Date_MonthPX161601100401Rubella Booster 2 Date - Month4N/A
PX161601_Rubella_Booster2_Date_DayPX161601100402Rubella Booster 2 Date - Day4N/A
PX161601_Rubella_Booster2_Date_YearPX161601100403Rubella Booster 2 Date - Year4N/A
PX161601_Rubella_Booster3_AgePX161601100500Rubella Booster 3 Age4N/A
PX161601_Rubella_Booster3_Date_MonthPX161601100601Rubella Booster 3 Date - Month4N/A
PX161601_Rubella_Booster3_Date_DayPX161601100602Rubella Booster 3 Date - Day4N/A
PX161601_Rubella_Booster3_Date_YearPX161601100603Rubella Booster 3 Date - Year4N/A
PX161601_Mumps_Booster1_AgePX161601110100Mumps Booster 1 Age4N/A
PX161601_Mumps_Booster1_Date_MonthPX161601110201Mumps Booster 1 Date - Month4N/A
PX161601_Mumps_Booster1_Date_DayPX161601110202Mumps Booster 1 Date - Day4N/A
PX161601_Mumps_Booster1_Date_YearPX161601110203Mumps Booster 1 Date - Year4N/A
PX161601_Mumps_Booster2_AgePX161601110300Mumps Booster 2 Age4N/A
PX161601_Mumps_Booster2_Date_MonthPX161601110401Mumps Booster 2 Date - Month4N/A
PX161601_Mumps_Booster2_Date_DayPX161601110402Mumps Booster 2 Date - Day4N/A
PX161601_Mumps_Booster2_Date_YearPX161601110403Mumps Booster 2 Date - Year4N/A
PX161601_Mumps_Booster3_AgePX161601110500Mumps Booster 3 Age4N/A
PX161601_Mumps_Booster3_Date_MonthPX161601110601Mumps Booster 3 Date - Month4N/A
PX161601_Mumps_Booster3_Date_DayPX161601110602Mumps Booster 3 Date - Day4N/A
PX161601_Mumps_Booster3_Date_YearPX161601110603Mumps Booster 3 Date - Year4N/A
PX161601_Measles_Booster1_AgePX161601120100Measles Booster 1 Age4N/A
PX161601_Measles_Booster1_Date_MonthPX161601120201Measles Booster 1 Date - Month4N/A
PX161601_Measles_Booster1_Date_DayPX161601120202Measles Booster 1 Date - Day4N/A
PX161601_Measles_Booster1_Date_YearPX161601120203Measles Booster 1 Date - Year4N/A
PX161601_Measles_Booster2_AgePX161601120300Measles Booster 2 Age4N/A
PX161601_Measles_Booster2_Date_MonthPX161601120401Measles Booster 2 Date - Month4N/A
PX161601_Measles_Booster2_Date_DayPX161601120402Measles Booster 2 Date - Day4N/A
PX161601_Measles_Booster2_Date_YearPX161601120403Measles Booster 2 Date - Year4N/A
PX161601_Measles_Booster3_AgePX161601120500Measles Booster 3 Age4N/A
PX161601_Measles_Booster3_Date_MonthPX161601120601Measles Booster 3 Date - Month4N/A
PX161601_Measles_Booster3_Date_DayPX161601120602Measles Booster 3 Date - Day4N/A
PX161601_Measles_Booster3_Date_YearPX161601120603Measles Booster 3 Date - Year4N/A
PX161601_Tuberculosis_Booster1_AgePX161601130100Tuberculosis Booster 1 Age4N/A
PX161601_Tuberculosis_Booster1_Date_MonthPX161601130201Tuberculosis Booster 1 Date - Month4N/A
PX161601_Tuberculosis_Booster1_Date_DayPX161601130202Tuberculosis Booster 1 Date - Day4N/A
PX161601_Tuberculosis_Booster1_Date_YearPX161601130203Tuberculosis Booster 1 Date - Year4N/A
PX161601_Tuberculosis_Booster2_AgePX161601130300Tuberculosis Booster 2 Age4N/A
PX161601_Tuberculosis_Booster2_Date_MonthPX161601130401Tuberculosis Booster 2 Date - Month4N/A
PX161601_Tuberculosis_Booster2_Date_DayPX161601130402Tuberculosis Booster 2 Date - Day4N/A
PX161601_Tuberculosis_Booster2_Date_YearPX161601130403Tuberculosis Booster 2 Date - Year4N/A
PX161601_Tuberculosis_Booster3_AgePX161601130500Tuberculosis Booster 3 Age4N/A
PX161601_Tuberculosis_Booster3_Date_MonthPX161601130601Tuberculosis Booster 3 Date - Month4N/A
PX161601_Tuberculosis_Booster3_Date_DayPX161601130602Tuberculosis Booster 3 Date - Day4N/A
PX161601_Tuberculosis_Booster3_Date_YearPX161601130603Tuberculosis Booster 3 Date - Year4N/A
PX161601_Hepatitis_B_Booster1_AgePX161601140100Hepatitis B Booster 1 Age4N/A
PX161601_Hepatitis_B_Booster1_Date_MonthPX161601140201Hepatitis B Booster 1 Date - Month4N/A
PX161601_Hepatitis_B_Booster1_Date_DayPX161601140202Hepatitis B Booster 1 Date - Day4N/A
PX161601_Hepatitis_B_Booster1_Date_YearPX161601140203Hepatitis B Booster 1 Date - Year4N/A
PX161601_Hepatitis_B_Booster2_AgePX161601140300Hepatitis B Booster 2 Age4N/A
PX161601_Hepatitis_B_Booster2_Date_MonthPX161601140401Hepatitis B Booster 2 Date - Month4N/A
PX161601_Hepatitis_B_Booster2_Date_DayPX161601140402Hepatitis B Booster 2 Date - Day4N/A
PX161601_Hepatitis_B_Booster2_Date_YearPX161601140403Hepatitis B Booster 2 Date - Year4N/A
PX161601_Hepatitis_B_Booster3_AgePX161601140500Hepatitis B Booster 3 Age4N/A
PX161601_Hepatitis_B_Booster3_Date_MonthPX161601140601Hepatitis B Booster 3 Date - Month4N/A
PX161601_Hepatitis_B_Booster3_Date_DayPX161601140602Hepatitis B Booster 3 Date - Day4N/A
PX161601_Hepatitis_B_Booster3_Date_YearPX161601140603Hepatitis B Booster 3 Date - Year4N/A
PX161601_Other_Booster1_AgePX161601150100Other Booster 1 Age4N/A
PX161601_Other_Booster1_Date_MonthPX161601150201Other Booster 1 Date - Month4N/A
PX161601_Other_Booster1_Date_DayPX161601150202Other Booster 1 Date - Day4N/A
PX161601_Other_Booster1_Date_YearPX161601150203Other Booster 1 Date - Year4N/A
PX161601_Other_Booster2_AgePX161601150300Other Booster 2 Age4N/A
PX161601_Other_Booster2_Date_MonthPX161601150401Other Booster 2 Date - Month4N/A
PX161601_Other_Booster2_Date_DayPX161601150402Other Booster 2 Date - Day4N/A
PX161601_Other_Booster2_Date_YearPX161601150403Other Booster 2 Date - Year4N/A
PX161601_Other_Booster3_AgePX161601150500Other Booster 3 Age4N/A
PX161601_Other_Booster3_Date_MonthPX161601150601Other Booster 3 Date - Month4N/A
PX161601_Other_Booster3_Date_DayPX161601150602Other Booster 3 Date - Day4N/A
PX161601__Other_Booster3_Date_YearPX161601150603Other Booster 3 Date -Year4N/A