inpatient / infectious Disease

Infectious Disease Social History Intake

Last Updated: 1/8/2023

-- Travel: *** domestic, international, where exactly, how long, what did you do when you were there, food and water consumed; take immunizations/prophylactics before going?
-- Work exposure: ***
homeless, military, prison populations
-- Drug Use: *** 
alcohol, tobacco, recreational (name, freq, last use), IV drugs
-- Sexual Hx: ***
number and genders of partners over last 12 months, practices - genital, anal, oral, protection, past hx of / testing for STI and if they were treated, prevention of preg
-- Hobbies: ***
garden, water, outdoors, etc
-- Dietary Hx: ***
raw, undercooked meat, unpasteurized milk, etc
-- Animal Exposure:
*** pets, zoos, wild, other

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