Demographic
|
Sex
| | | | | ✓ | |
Date of birth
| | | | | ✓ | |
Marital status
| ✓ | | ✓ | | | ✓ |
Country of birth
| | | ✓ | | ✓ | |
Immigration date
| | | ✓ | | ✓ | |
Ethnicity by country of birth of individual, the parents, or grandparents
| | | ✓ | | ✓ | |
Socio-economic status by clinic address
| | | ✓ | | ✓ | ✓ |
Supplementary insurance status
| | | ✓ | | ✓ | |
Dates enrolled as CHS member
| | | ✓ | | ✓ | |
Level of education
| ✓ | | | | | ✓ |
Household composition (number of rooms; number of family members in the house)
| ✓ | | | | | ✓ |
Occupation and work responsibilities
| ✓ | | | | ✓ | ✓ |
Family income
| ✓ | | | | | ✓ |
Health Status and Risk Behaviors
| | | | | | |
Health status and health behaviors
| ✓ | ✓ | | | ✓ | |
Smoking status, history
| | | ✓ | | ✓ | |
Pack years
| | | ✓ | | ✓ | |
Height
| | | ✓ | | ✓ | |
Weight
| | | ✓ | | ✓ | |
Body mass index
| | | ✓ | | ✓ | |
Medication use for chronic conditions and immunosuppressants
| | | ✓ | | ✓ | |
Attitudes
| | | | | | |
Perceptions of illness, vaccines, missing work
| ✓ | | | | | ✓ |
Recollection of influenza vaccination (for vaccinated HCP)
| | ✓ | | | | ✓ |
Reasons for not receiving the influenza vaccine (for unvaccinated HCP)
| | ✓ | | | | ✓ |
Job satisfaction
| ✓ | | | | | ✓ |
Influenza Vaccination Documentation
| | | | | | |
Vaccine administration date
| | | ✓ | | ✓ | ✓ |
Vaccine type
| | | ✓ | | ✓ | ✓ |
Vaccine manufacturer & lot
| | | ✓ | | ✓ | ✓ |
Employee Records of Illness Absences
| | | | ✓ | | ✓ |
Acute Respiratory Illness
| | | | | | |
Number of inpatient admissions associated with acute illness
| | | ✓ | | ✓ | ✓ |
Chronic Medical Conditions and Pregnancy
| | | | | | |
Number of ambulatory or inpatient medical encounters associated with chronic medical condition
| | | ✓ | | ✓ | ✓ |
Chronic medical conditions
| | | ✓ | | ✓ | |
Pregnancy
| | | | | ✓ | ✓ |