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SectionTx sectionData Field DescriptionData typeFormatPermissible values EN (response options)CIEL IDDefault NameClass
Data type
CIEL CommentSource: PIH
Source: WHO
Source: CDC
Source: DHIS2
Source: OpenEMR Dictionary
2
GeneralReporting Date (DD/MM/YYYY)*: _____/____/______Date of reportingDateDD/MM/YYYY
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GeneralReporting reporting institution Facility ? Include. MFR ID165846Name of reporting institution
Question
Text
4
GeneralReporting reporting countrycountry (? ID) 165847Reporting country
Question
Coded
5
GeneralReporting Why the case was tested for COVID-19Why the case was tested for COVID-19Coded
Coded variables
CASE_CONTACT, SEEKING_HC, POE_DETECTION, REPATRIATION, SURVEILLANCE, UNKNOWN, OTHER
164126Reason for testing
Question
Coded
6
GeneralReporting Explain if none of the answers to number 5Any other reason the case was tested for COVID-19StringFree text163761Reason for testing (text)
Question
TextUsually captured with OTHER and text field
7
GeneralReporting case classificationIs the case confirmed, probable, or suspected, as per case definitionNumeric#CONFIRMED, PROBABLE165793Case classificationFindingCoded
8
GeneralReporting detected at point of entryWas the case detected at a point of entry?Numeric#YES, NO, UNKNOWN165651Detected at point of entryFindingCoded
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GeneralReporting date detected at point of entryWhat date was the case detected at a point of entryDateDD/MM/YYYY162869Date/time recordedFinding
datetime
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GeneralPatient informationDate of birth*:_____/______/________DOBDateDD/MM/YYYY
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GeneralPatient informationor Age:_______Age in units on the date of illness onset.Numeric###0-110
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GeneralPatient informationunit of ageYears or months or daysCoded
Coded variables
YEARS, MONTHS, DAYS
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GeneralPatient informationSex at birth: Male Femalebiological sexCoded
Coded variables
MALE, FEMALE
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GeneralPatient informationCountry. where case was diagnosedCountry codeStringFree text165794Location of diagnosis setFindingN/ANote that country codes are short names for country default names. Recommend we create an array for case details like 162726.
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GeneralPatient informationProvince or additional information- adminsitrative country level (e.g. province, state, territory prefecture, region, etc.) where the case was diagnosed.StringFree textCountry (165657)
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GeneralPatient informationDistrict level. (e.g. district, county, local government area, department, province, municipality, etc.) where the case was diagnosed.StringFree textProvince (165851)
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GeneralPatient informationCountry place of residence Country within which the case's currently/usually resides.StringFree textDistrict (162689)
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GeneralPatient informationProvince or next level residents (e.g. province, state, territory prefecture, region, etc.) within which the case's currently/usually resides.StringFree textVILLAGE (1354)
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GeneralPatient informationnext level of residence (e.g. district, county, local government area, department, province, municipality, etc.) within which the case's currently/usually resides.StringFree text
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GeneralLabDate of first laboratory confirmation Date of first laboratory confirmation DateDD/MM/YYYY
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GenerallabLab test usedLOINC code or lab test used.
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GenerallabLab test usedLOINC code or lab test used.
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GeneralClinical statusDate of onset of current first symptoms:____/____/______Date of first appearance of the signs or symptoms of the illness/disease. DateDD/MM/YYYY
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GeneralClinical statusPatient asymptomatic at time of speciment collectionIs the case asymptomatic?Coded
Coded variables
YES, NO, UNKNOWN1730Sign/symptom start date
Question
datetime
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GeneralClinical statusPatient date of onset unknownIs the date of the case's symptom onset unknown?Numeric# YES, NO5006AsymptomaticMiscN/AMay need to change to coded depending on modeling
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GeneralClinical statusDoes the patient have any underlying conditions?Does the patient have any underlying conditions?Coded
Coded variables
YES, NO, UNKNOWN162747Co-morbid conditionsFindingcoded
27
GeneralpregnancyPregnancy Is the patient pregnant? Coded
Coded variables
YES, NO1434Currently pregnantFindingBoolean
28
GeneralpregnancyTrimester of pregancyCoded
Coded variables
FIRST, SECOND, THIRD160665Trimester of pregnancy
Question
Coded
29
GeneralpregnancyPost-partum (<6 weeks)Is the patient in the post partum period defined as less than 6 weeks after delivery dateCoded
Coded variables
YES, NO129317Postpartum state
Diagnosis
Coded
30
Generalclinical historyImmunocompromised including HIVhas the patient an adquired immunodeficiency (HIV) or is the patient treated with drugs that decreased immune response (corticoides, anti cancer chemotherapy)? Coded
Coded variables
YES, NO117277Immunologic deficiency syndrome
Diagnosis
Coded
31
Generalclinical historyCardiovacsular disease including hypertensionany cardiovacsular diseaseCoded
Coded variables
YES, NO119270Cardiovascular disease
Diagnosis
Coded
32
Generalclinical historyDiabetesCoded
Coded variables
YES, NO119481Diabetes Mellitus
Diagnosis
Coded
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Generalclinical historyLiver diseaseany liver diseasesCoded
Coded variables
YES, NO6032Hepatic disease
Diagnosis
Coded
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Generalclinical historyRenal disease any renal diseases Coded
Coded variables
YES, NO6033Renal disease
Diagnosis
Coded
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Generalclinical historyChronic neurological or neuromuscular diseaseCoded
Coded variables
YES, NO165646Chronic neurological or neuromuscular diseaseFindingCoded
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Generalclinical historyMalignancyCoded
Coded variables
YES, NO116031Malignant neoplasm
Diagnosis
Coded
37
Generalclinical historyChronic lung diseaseCoded
Coded variables
YES, NO155569Chronic lung disease
Diagnosis
Coded
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Generalclinical historyCardiovascular disease 119270Cardiovascular disease
Diagnosis
Coded
39
Generalclinical historyOther chronic diseases
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Generalclinical historyother, specifyother underlying condition, comorbidityfree text
41
Generalhealth factorCurrent smoker152722Smoker
Diagnosis
Coded
42
Generalhealth factorFormer smoker152807Former smoker
Diagnosis
Coded
43
Generalclinical courseAdmission to hospitalWas the case hospitalized, admitted to a hospital or other health facility as an inpatient?Coded
Coded variables
YES, NO, UNKNOWN163403Previously hospitalized
Question
Coded
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Generalclinical courseFor this episode, date first admitted in hospitalDate the case was first admitted to any health facility. DateDD/MM/YYYY1640Admission Date-Time
Question
datetime
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Generalclinical courseName of hospital Name of health facility where the case was admitted. (Maybe use MFR)StringFree text162724Health facility name
Question
Text
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Generalclinical courseDid the patient receive care in an ICU?Did the patient receive care in an intensive care unit (ICU)?Coded
Coded variables
YES, NO, UNKNOWN165644History of admission to intensive care unit (ICU)FindingCoded
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Generalclinical courseWas the patient ventilated? Was the patient ever ventilated for this episode at time of reporting?Coded
Coded variables
YES, NO, UNKNOWN165647History of mechanical ventilationFindingCoded
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Generalclinical courseDid the patient receive ECMO? Did the patient receive extracorporeal membrane oxygenation (ECMO)? Coded
Coded variables
YES, NO, UNKNOWN165643History of extracorporeal membrane oxygenation (ECMO)FindingCoded
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GeneralClinical statusWas the case isolated?Was the case isolated with proper IPC controls implemented?Coded
Coded variables
YES, NO, UNKNOWN165795History of proper isolation procedureFindingCoded
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Generalclinical coursedate of isolationWhat date was the case isolated?DateDD/MM/YYYY165648Date of isolation
Question
datetime
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Generalclinical courseOutcome of illness (circle):Health Status at time of reporting.Numeric#
1 = recovered ; 2 = not recovered; 3 = death; 4 = unknown
See 159640 for possible reusable status. Can we map from Good, Poor, Dead?
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Generalclinical courseDate of deathDate of deathDateDD/MM/YYYY1543Date of deathFindingDate
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GeneralsymptomsFever greater than 100.4Fever associated with chills or not Numeric#1 = Yes; 2 = No140238Fever
Diagnosis
Coded
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GeneralsymptomsSubjecitve. Fever (feels feverish) 140471Feeling feverishFindingN/A
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GeneralsymptomsChills871ChillsFindingCoded
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GeneralsymptomsMuscle Aches 121MyalgiaFindingN/A
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GeneralsymptomsRunny nose165501Rhinorrhea
Symptom
N/A
58
GeneralsymptomsSore throat158843Sore Throat
Diagnosis
N/A
59
GeneralsymptomsCough143264Cough
Diagnosis
N/A
60
GeneralsymptomsShortness of breath141600Shortness of breath
Diagnosis
N/A
61
GeneralsymptomsNausea/vomiting133473Nausea and vomiting
Diagnosis
N/A
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GeneralsymptomsHeadache139084Headache
Diagnosis
N/A
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GeneralsymptomsAbdominal pain151Abdominal pain
Symptom
N/A
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GeneralsymptomsDiarrhoea (greater than three loose/lloser than normal stools/24 hours)142412Diarrhea
Diagnosis
Coded
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GeneralsymptomsGeneral weaknessIntense fatigue, an abnormal state of drowsiness (lethargy or feeling lethargic), cannot conduct daily activity, lack of strengh Numeric#1 = Yes; 2 = No5226Weakness
Symptom/finding
N/A
66
GeneralsymptomsIrritability/confusionPresence of any conscious disorderNumber#1 = Yes; 2 = No118876Alteration of consciousness
Diagnosis
N/A
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GeneralsymptomsPainPatient complains of pain, at any siteNumeric#1 = Yes; 2 = No114403Pain
Diagnosis
N/A
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GeneralsymptomsChest painChest painNumeric#1 = Yes; 2 = No120749Chest pain
Diagnosis
N/A
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GeneralsymptomsOther, specifyDescribe other symptomsStringFree text
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Generalvital signsTemperature:Body temperature measured at time of interview or upon admission to the medical facility
Expressed in degree celcius
Numeric##
between 35 and 43 or 95 and 110
5088Temperature (C)FindingNumeric
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GeneralpePharyngeal exudatePharyngitis or laryngitis Numeric#1 = Yes; 2 = No165892Pharyngeal exudateFindingCoded
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GeneralpeConjunctival injectionBleeding/haemorrhage into the eyes (conjunctival injections).Numeric#1 = Yes; 2 = No517Conjunctival injectionsFindingCoded
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GeneralpeDyspnea, tachypneaRapid respiration Numeric#1 = Yes; 2 = No125061TachypneaFindingCoded
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GeneralpeAbnormal lung auscultation Any sign resulting from pulmonary auscultationNumeric#1 = Yes; 2 = No150876Abnormal breath soundsFindingCoded
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GeneralpeAbnormal lung x-ray findingsPulmonary Xrays showing abnormal patterns Numeric#1 = Yes; 2 = No154435abnormal findings on diagnostic imaging of lungFindingCoded
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GeneralpeSeizuresMyoclonies, tremors, epilepsy, seizures/convulsionsNumeric#1 = Yes; 2 = No206Seizure
Diagnosis
Coded
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GeneralpeComaAbsence of reaction to ordersNumeric#1 = Yes; 2 = No144576Coma
Diagnosis
Coded
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GeneralpeOther signs, specifyDescribe other signsStringFree text
79
Case Reporting
Exposure and travelstudentstudent#1-yes; 2- No159465studentMisc.N/A
80
Case Reporting
Exposure and travel information
Healthcare workerIs the patient working in a health care setting? Coded
Coded variables
YES, NO, UNKNOWN5619Health care providerMisc.CodedMight need to look at this one
81
Case Reporting
Exposure and travel information
Health laboratory workerIs the patient working in a health laboratory setting?Numeric#1 = Yes; 2 = No165796Medical Lab technicianMisc.N/A
82
Case Reporting
Exposure and travel information
Working with animalsIs the patient working in contact with animals? Numeric#1 = Yes; 2 = No165834Works with animalsFindingCoded
83
Case Reporting
Exposure and travel information
Other, specifyPlease specify any other occupation not listedStringFree text
84
Case Reporting
Exposure and travel information
Healthcare worker countryIf case is a healthcare worker, in which country do they work?StringFree text165655Country of employment
Question
TextShould this be coded?
85
Case Reporting
Exposure and travel information
Healthcare worker cityIf case is a healthcare worker, in which city do they work?StringFree text165654City where employed
Question
Text
86
Case Reporting
Exposure and travel information
Healthcare worker facility nameIf case is a healthcare worker, what is the name of the facility in which they work?StringFree text162724Health facility name
Question
TextThis needs to be part of a construct to differentiate other health facility names
87
Case Reporting
Exposure and travel information
Has the patient travelled in the 14 days prior to symptom onset?Has the patient travelled in the 14 days prior to symptom onset?Coded
Coded variables
YES, NO, UNKNOWN165656History of recent travel in past 14 days
Question
Coded
88
Case Reporting
Exposure and travel information
Specify country travelled to 1List the country from location 1 that the case has travelled to in the 14 days prior to symptom onsetStringFree text
89
Case Reporting
Exposure and travel information
Specify city travelled to 1List the city from location 1 that the case has travelled to in the 14 days prior to symptom onsetStringFree text
90
Case Reporting
Exposure and travel information
Specify date departed from 1List the date departed from location 1 that the case has travelled to in the 14 days prior to symptom onsetDateDD/MM/YYYY
91
Case Reporting
Exposure and travel information
Specify country travelled to 2List the country from location 2 that the case has travelled to in the 14 days prior to symptom onsetStringFree text
92
Case Reporting
Exposure and travel information
Specify city travelled to 2List the city from location 2 that the case has travelled to in the 14 days prior to symptom onsetStringFree text
93
Case Reporting
Exposure and travel information
Specify date departed from 1List the date departed from location 1 that the case has travelled to in the 14 days prior to symptom onsetDateDD/MM/YYYY
94
Case Reporting
Exposure and travel information
Specify country travelled to 3List the country from location 3 that the case has travelled to in the 14 days prior to symptom onsetStringFree text
95
Case Reporting
Exposure and travel information
Specify city travelled to 3List the city from location 3 that the case has travelled to in the 14 days prior to symptom onsetStringFree text
96
Case Reporting
Exposure and travel information
Specify date departed from 1List the date departed from location 1 that the case has travelled to in the 14 days prior to symptom onsetDateDD/MM/YYYY
97
Case Reporting
Exposure and travel information
Has the patient visited any health care facilities in the 14 days prior to symptom onsetHas the patient visited any health care facilities in the 14 days prior to symptom onsetCoded
Coded variables
YES, NO, UNKNOWN165833Visited health facility in past two weeks
Question
Coded
98
Case Reporting
Exposure and travel information
Has the patient had close contact with a person with acute respiratory infection in the 14 days prior to symptom onsetHas the patient had close contact with a person with acute respiratory infection in the 14 days prior to symptom onsetNumeric#
1 = Yes; 2 = No; 3 = Unknown
165850Close contact with person with acute respiratory infection 14 days prior to developing symptoms
Question
Coded
99
Case Reporting
Exposure and travel information
ARI close contact in Health care settingHas the patient had close contact with a person with acute respiratory infection in the 14 days prior to symptom onset in a health care setting?Numeric#1 = Yes; 2 = No
100
Case Reporting
Exposure and travel information
ARI close contact in Family settingHas the patient had close contact with a person with acute respiratory infection in the 14 days prior to symptom onset in a family setting?Numeric#1 = Yes; 2 = No