Exposure questionnaire : 2022 monkeypox response
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Exposure questionnaire : 2022 monkeypox response

Filetype[PDF-334.69 KB]


English
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Details:

  • Corporate Authors:
    Centers for Disease Control and Prevention (U.S.)
  • Description:
    5/21/2022

    These are suggested questions to include in a patient interview tool for local use during the May 2022 monkeypox response. These questions are focused on patient exposures prior to illness onset. Highlighted sections in yellow include key questions designed for this specific monkeypox investigation. Other questions are general and can be incorporated as necessary to fit the specific context.

    Monkeypox-Exposure-Questionnaire.pdf

  • Content Notes:
    Section 1: Interview information -- Section 2: Patient demographics -- Section 3: Household demographics -- Section 4: Patient medical history -- Section 5: Patient illness characteristics -- Section 6: Exposures in the 21 days before illness onset to present -- Section 6A: Ill person contacts -- Section 6B: Sexual behavioral questions -- Section 6C: Travel, animal, and product exposures -- Section 7: Laboratory testing (information likely needs to be collected from medical records).
  • Subjects:
  • Document Type:
    Pamphlet (or booklet)
  • Genre:
    Questionnaire
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