Demographic/Clinical Data Elements for Sites Conducting

"Gonnococal Isolates Surveillance Project (GISP) Clinical and Demographic Data
Enhanced data collection",,,,,,,,,,,,,,,OMB Control No. 0920-0307 Expiration Date: xx/xx/XXXX,,,,,,,,,,,,,,,,,,,,,,
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"Public reporting burden of this collection of information is estimated to average 12 minutes per response, including the time for reviewing instructions, searching for existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-0307",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
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Clinic,Clinic ID,GISP ID,Patient ID,Specimen ID (eGISP ID),Date of Visit,Patient Gender,Age,Ethnicity,American Indian/Alaskan Native,Asian,Black,Native Hawaiian/Pacific Islander,White,Other,Cis Female Sexual Partners,Cis Male Sexual Partners,Trans Female Sexual Partners,Trans Male Sexual Partners,Female Partners (Unknown Gender),Male Partners (Unknown Gender),Unknown,Specimen type,Symptoms,Previous hx of gonorrhea (ever),# of previous episodes (past 12 mos.),HIV status,Travel history,Sex work exposure,Previous antibiotic use,IDU,Non-IDU,Treatment 1,Other Treatment 1,Treatment 2,Other Treatment 2,Nucleic Accid Amplification Test (NAAT) result,Nm Vaccine