HISTORY:
Presents for a pre-travel assessment
Destination:
Duration of stay:
Departure date:
Return date:
Purpose of travel:
Planned activities:
Health travel insurance:
Vaccinations:
Hepatitis A:
Hepatitis B:
Typhoid:
Yellow fever:
Traveler's diarrhea:
Japanese encephalitis:
Rabies:
Meningococcal:
COVID-19:
EXAM:
General appearance:
Vital signs: , BP , HR , RR , SpO2 %, Temp °
ASSESSMENT:
Pre-travel assessment
PLAN:
- Blood work: ,
- Vaccinations: , , , , , , if risk of animal bites,
- Malaria prophylaxis:
- Traveler's diarrhea: , , advice given on food and water precautions
- Motion sickness:
- Altitude sickness:
- Sun protection: , , advice given on sun avoidance and protective clothing
- Insect bite prevention: , , advice given on insect avoidance and protective clothing at night
- Referral to travel medicine clinic
- Follow-up post-travel