| Health Background |
| Past medical history |
- Age
- Sex
- Underlying conditions
- Allergies (especially any pertaining to vaccines, eggs, or latex)
- Medications
|
| Special conditions |
- Pregnancy (including trimester)
- Breastfeeding
- Disability or handicap
- Immunocompromising conditions or medications
- Older age
- Psychiatric condition
- Seizure disorder
- Recent surgery
- Recent cardiopulmonary event
- Recent cerebrovascular event
- History of Guillain-Barré syndrome
- Severe allergies
|
| Immunization history |
- Routine vaccines
- Travel vaccines
|
| Prior travel experience |
- Experience with malaria chemoprophylaxis
- Experience with altitude
- Illnesses related to prior travel
|
| Trip Details |
| Itinerary |
- Countries and specific regions, including order of countries if >1 country
- Rural or urban
|
| Timing |
- Trip duration
- Season of travel
- Time to departure
|
| Reason for travel |
- Tourism
- Business
- Visiting friends and relatives
- Volunteer, missionary, or aid work
- Research or education
- Adventure
- Pilgrimage
- Adoption
- Seeking health care (medical tourism)
|
| Travel style |
- Independent travel or package tour
- Propensity for "adventurous" eating
- Traveler risk tolerance
- General hygiene standards at destination
- Modes of transportation
- Accommodations (such as tourist or luxury hotel, guest house, hostel or budget hotel, dormitory, local home or host family, or tent)
|
| Special activities |
- Disaster relief
- Medical care (providing or receiving)
- High altitude
- Diving
- Cruise ship
- Rafting or other water exposure
- Cycling
- Extreme sports
- Spelunking
- Anticipated interactions with animals
- Anticipated sexual encounters
|