Case Surveillance by Health Department Manager

Form Approved
OMB No. 0920-14AQA
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Enhanced STD Surveillance Network (eESSuN)

Att. 3C
eSSuN Gonorrhea Case Surveillance Data Elements

There is no public burden to collecting this information; state and local health departments routinely conduct disease
reporting from provider and laboratory sources with case definitions and methods developed in collaboration with the
Council for State and Territorial Epidemiologists (CSTE) and CDC. 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, Project Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA
(0920-14AQA). Do not send the completed form to this address.

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Gonorrhea Routine Case Surveillance Data Elements

1

P1_SiteID

SSuN Site ID
This 2 character code primarily identifies sites funded under eSSuN Cycle
3 and may include additional sites as required throughout the grant
period.

BA=Baltimore
CA=California
FL=Florida
MA=Massachusetts
MN=Minnesota
MC=Multnomah County
NY=New York City
PH=Philadelphia
SF=San Francisco
WA=Washington
Supplemental codes – for historical data only:
VA=Virginia (Cycle II)
AL=Alabama (Cycle II)
CO=Colorado (Cycle II)
CH=Chicago (Cycle II)
This data element cannot be ‘null’ or contain missing values.
2

P1_EventID

Site generated unique event identifier
This record ID should be supplied by the site and may be an event or
report identifier from underlying surveillance system. Regardless of
source, this ID must be unique for each confirmed case report. This
data element cannot be ‘null’ or contain missing values.

3

P1_PatientID

Site generated ID allows for longitudinal tracking of unique persons
This ID should be supplied by the site and may be a unique patient
identifier from underlying surveillance systems or may be generated
specifically for eSSuN from identifying information provided through
case reporting. Regardless of source, this ID must be unique and allow
for longitudinal tracking of persons reported with multiple episodes of
disease. This data element cannot be ‘null’ or contain missing values.

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4

P1_RecRepDte

Earliest date this specific disease event/report received at health
department?
This date should reflect the earliest information available to the health
department regarding the case. This date should include laboratory
records received if lab results were reported prior to receipt of a
provider case report.

5

P1_RandSamp

Is this record/case selected in the random sample?
This data element cannot be ‘null’ or contain missing values.
0=Not in random sample
1=In random sample

6

P1_SampDte

Date record/case sampled by jurisdiction
For jurisdiction deploying a batch process for record sampling, this
should be the actual date that the batch was sampled. For
jurisdictions deploying real-time sampling of cases through their
surveillance system, this date should match the report date (or date
case status was confirmed if appropriate). This data element cannot
be ‘null’ or contain missing values.

7

P1_RecSx

Was lab or provider report how case was initially reported to the health
department?
This data element is intended to capture the source of the initial case
notification to the health department. If the grantee is not able to
reliably capture this information for a specific case, this must be
documented by entering a value of ‘3’ for that case record. This data
element cannot be ‘null’ or contain missing values.
0=Laboratory report, electronic
1=Laboratory report, paper
2=Provider report, electronic or paper
3=Report source not captured by surveillance system

8

P1_PrevPtx

Is patient previously known to HD from infectious disease reporting
records (TB, HIV, STDs, Hep)?
This data element is designed to capture whether this patient is known
to the HD from a previous case report. This data element cannot be
‘null’ or contain missing values. If a match with previous patients is
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not done, please code as a new patient. If a subsequent match is
performed and patient found to be previously reported, the value
should be changed accordingly.
0=New Patient, not previously reported
1=Patient previously reported

9

P1_InitSx

If patient previously reported, what is the registry/source of earliest
report for this PATIENT?
0=STD Registry
1=HIV Registry
2=Viral Hepatitis Registry
3=Other Disease Registry
4=Unknown

10

P1_HregMatch

Was eHARS registry match done for this patient?
This data element may be initially coded as ‘2’ if the grantee conducts
a batch match with their HIV registry and the case is reported before
that batch is processed. This information can be updated in the eSSuN
record in the next data transmission following the match. This data
element cannot be ‘null’ or contain missing values.
1=Yes
2=No

11

P1_HregMatchStat

Did this patient match a registry entry in eHARS?
This data element may be initially coded as ‘3’ if the grantee conducts
a batch match with their HIV registry and the case is reported before
that batch is processed. This information can be updated in the eSSuN
record in the next data transmission following the match. This data
element cannot be ‘null’ or contain missing values.
1=Matching Record Found
2=No Matching Record
3=Match Not Performed

12

P1_HDXMOYR

What is this patient's earliest indication of HIV positive result?
This information can be obtained from the eHARS person table
(HIVPMOYR).
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13

P1_Othno

Additional registry number
If this patient also has a record in other/ancillary disease registries.
This is primarily for local use in matching patient records to update
missing information.

14

P1_Othsx

Additional registry source
If this patient also has a record in other/ancillary disease registries and
P1_Othno is not blank, this element should be populated with the
source.
0=STD Registry
1=HIV Registry
2=Viral Hepatitis Registry
3=Other Disease Registry
4=Unknown

15

P1_PrevDx
HIV)

Most recent previous diagnosis (if applicable; could include hep, TB or
If this patient also has a record in other/ancillary disease registries as
indicated by #13 & 14 above, what was the initial diagnosis indicated
by that record? Should be ‘Null’ if no previous diagnosis is confirmed.
10311=Syphilis, primary
10312=Syphilis, secondary
10313=Syphilis, early latent
10315=Syphilis, unknown latent
10314=Syphilis, late latent
10318=Syphilis, late with symptoms
10280=Gonorrhea
10274=Chlamydia
10100=Hepatitis B, acute
10105=Hepatitis B, chronic
20001=Hepatitis C
10562=HIV infection (non-AIDS)
10560=AIDS
10307=Nongonococcal Urethritis (NGU)
10308=Muco-purulent cervicitis (MPC)
10309=Pelvic Inflammatory Disease (PID)
10273=Chancroid
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10306=Lymphogranuloma venereum (LGV)
10276=Granuloma Inguinale
20002=TB
20003=Other

16

P1_PrevDxDte

Date of most recent previous diagnosis documented above.
Must not be null if P1_PrevDx is not null.

16.1 P1_PrevGCDx

Has the patient been previously diagnosed and reported with GC?
1=Yes
2=No
3=Registry records not searched

16.2 P1_PrevGCDxDte

Date of most recent previous diagnosis of GC documented above.
Must not be null if P1_PrevGCDx = 1

17

P1_CaseDup

Is this record/case a duplicate report, new report or was duplicate
status not determined?
The grantee should document if an initial case report was
subsequently found to be a duplicate of an existing case – the record
should be retained in the eSSuN dataset and coded as a duplicate (‘1’)?
If the jurisdiction receives a report that they know to be a duplicate at
the time of report, the record can be omitted from the eSSuN datasets
and not sampled for enhanced investigation. This data element cannot
be ‘null’ or contain missing values.
0=New Case
1=Duplicate Case (previously reported <15 days)
9=Unknown, site surveillance system does not capture

18

P1_FacilityID

Site generated facility ID. Each reporting provider/facility must have a
unique facility ID and link to a record in the provider table.
This is a primary key for linking the provider type and other provider
information to the case record. Historically, the majority of cases in
any grantee’s jurisdictions will be reported from known providers, but
for cases reported from entirely new providers, this field should be
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populated with that facility’s new number and be included in the next
update of the provider reference file.

19

P1_Dispo

What is the status of the internal health department (Phase 1)
investigation for this record?
The investigation referred to for this data element includes the search of
existing health department records, matching and merging with electronic or
other laboratory data, eHARS match and other disease registries. At initial
report, cases may be coded as ‘10’. This should be updated as appropriate.
Cases listed as pending should be updated within 60 days and this information
updated in the next eSSuN data transmission. This data element cannot be
‘null’ or contain missing values. Jurisdictions may choose to initiate phase 1
investigations on all reported cases, regardless of whether they fall into the
random sample, or may elect to initiate phase 1 investigations on only those
records in the random sample.
0=Investigation complete: record referred to phase 2
1=Investigation complete: no further action, record determined
to be a duplicate of previously reported case
2=Investigation complete: no further action, case determined to
reside outside of jurisdiction based on existing department of
health information
3=Investigation complete: no further action, case not in eSSuN
random sample
4=Investigation complete: no further action, case not eligible for
eSSuN sample
10=Investigation not complete: P1 investigation pending
11=Investigation not complete: no further action, insufficient
information in originating record to initiate and complete
internal investigation
22=Investigation not complete: record not in random sample

20

P1_Referral1

Is this record/case referred for provider (Phase 2) investigation?
This indicates whether the record has been referred to provider
investigation (methods of which will differ across eSSuN sites). If
provider is not contacted, surveyed or otherwise followed up with to
supply any additional case-specific information, code as ‘1’.
0=Referred to P2 Investigation
1=Not Referred to P2 Investigation
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2=Referral Pending

21

P1_PtxSex

Sex of the patient as indicated on initial health department report?
This data element cannot be ‘null’ or contain missing values.
1=Male
2=Female
3=Male-to-Female TG
4=Female-to-Male TG
5=TG Unknown or Unspecified
9=Unknown

22

P1_PtxRace_White

White Race
Information from case/lab reports to the health department only.
Patient self-report from interviews should be captured in #110 – 116.
If additional information from any source (other than patient report) is
received, #22 through 27 may be updated as required by underlying
surveillance system.
1=Yes
2=No
3=Unknown
4=Refused

23

P1_PtxRace_Black

Black Race
Information from case/lab reports to the health department only.
Patient self-report from interviews should be captured in #110 – 116.
If additional information from any source (other than patient report) is
received, #22 through 27 may be updated as required by underlying
surveillance system.
1=Yes
2=No
3=Unknown
4=Refused

23

P1_PtxRace_AIAN

American Indian/Alaska Native Race
Information from case/lab reports to the health department only.
Patient self-report from interviews should be captured in #110 – 116.
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If additional information from any source (other than patient report) is
received, #22 through 27 may be updated as required by underlying
surveillance system.
1=Yes
2=No
3=Unknown
4=Refused

25

P1_PtxRace_Asian

Asian Race
Information from case/lab reports to the health department only.
Patient self-report from interviews should be captured in #110 – 116.
If additional information from any source (other than patient report) is
received, #22 through 27 may be updated as required by underlying
surveillance system.
1=Yes
2=No
3=Unknown
4=Refused

26

P1_PtxRace_NHOPI

Native Hawaiian/Other Pacific Islander Race
Information from case/lab reports to the health department only.
Patient self-report from interviews should be captured in #110 – 116.
If additional information from any source (other than patient report) is
received, #22 through 27 may be updated as required by underlying
surveillance system. .
1=Yes
2=No
3=Unknown
4=Refused

27

P1_PtxRace_Other

Other Race
Information from case/lab reports to the health department only.
Patient self-report from interviews should be captured in #110 – 116.
If additional information from any source (other than patient report) is
received, #22 through 27 may be updated as required by underlying
surveillance system.
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1=Yes
2=No
3=Unknown
4=Refused

28

P1_PtxRace_UNK

Is all information on race and Hispanic ethnicity missing from initial
reporting record/documents?
If additional/supplemental information is received on race and
ethnicity of patient but this information was missing from the initial
report to the health department, please leave this data element coded
as ‘1’ and capture the source of supplemental information in #29
below.
1=Yes
2=No

29

P1_PtxRaceSource
for this patient?

What is the source of the final race information of record as ascertained
For grantees able to distinguish the source of information for race,
please indicate as appropriate. For grantees NOT able to distinguish
the source of race data at all, code as ‘6’. If race information is
missing/unknown from all sources, code as ‘5’.
1=Patient Self-Report
2=Provider Case Report
3=Laboratory Report
4=Previous Registry Record
5=No Information Available from Any Source
6=Source not Identifiable

30

P1_PtxHisp

Patient Hispanic ethnicity
Information from case/lab reports to the health department only.
Patient self-report from interviews should be captured in #109. If
additional information from any source (other than patient report) is
received, #30 may be updated as required by underlying surveillance
system.
1=Hispanic
2=Non-Hispanic
3=Unknown
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4=Refused

31

P1_PtxHISPSource
ascertained for

What is the source of the final Hispanic ethnicity information
this patient?
For grantees able to distinguish the source of information for Hispanic
ethnicity, please indicate as appropriate. For grantees NOT able to
distinguish the source of Hispanic ethnicity data at all, code as ‘6’. If
information is missing/unknown from all sources, code as ‘5’.
1=Patient Self-Report
2=Provider Case Report
3=Laboratory Report
4=Previous Registry Record
5=No Information Available from Any Source
6=Source not Identifiable

32

P1_PtxAGE

Age of patient from initial reporting record/document .
If age information is missing/unknown from all sources, use null value.

33

P1_PtxAgeUnit

Age unit
If #32 is null, use null value for this data element (‘.’)
1=Years
2=Months

34

P1_PtxCountyres

County of patient residence (FIPS)
If information is missing/unknown, code to null value ( ‘.’)

35

P1_PtxCTract

Census Tract of patient residence
If information is missing/unknown, code to null value (‘.’)

36

P1_PtxAddrStat

Was patient street address present and complete in initial reporting
documents?
This data element cannot be ‘null’ or contain missing values.
1=Street Address Known
2=Street Address Missing
3=Street Address Incomplete
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37

P1_GCAccuracy

What is the basis of census tract assignment (XY coordinates, street
segment, place/zip centroid, not geocodable)?
This data element cannot be ‘null’ or contain missing values.
1=Close (based on direct street segment, parcel, or l
ongitude/latitude match)
2=Approximate (modification of address required to match to
street segment)
3=Very approximate (based only on zip or city centroid)
4=Not-geocodable (insufficient data to geocode, PO Box,
General Delivery)
5=Data suppressed by Site policy
9=Missing (no address available)

38

P1_DxDte

What is the diagnosis date for the current episode of disease (may be
date of provider visit, specimen collection date, laboratory report date
or other suitable proxy)
This data element cannot be ‘null’ or contain missing values.

39

P1_DxCode

Diagnosis (for gonorrhea cases, this value = 10280)
This data element cannot be ‘null’ or contain missing values.
10280=Gonorrhea

40

P1_SiteUrine

Urine 'site' of infection, usually a proxy for urethral infection in men but
not as specific for women.
If information is missing/unknown, code as ‘3’
1=Yes
2=No
3=Unknown

41

P1_SiteVagCerv

Vaginal or cervical site of infection in women - combined because there
are no clear analytic reasons to separate.
If information is missing/unknown, code as ‘3’
1=Yes
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2=No
3=Unknown

42

P1_SiteUreth

Urethral site of infection - only if this is specifically indicated, if the only
specimen source available is a urine-based NAAT, default to 'Urine'
If information is missing/unknown, code as ‘3’
1=Yes
2=No
3=Unknown

43

P1_SiteRect

Rectal site of infection
If information is missing/unknown, code as ‘3’
1=Yes
2=No
3=Unknown

44

P1_SitePhar

Pharyngeal site of infection
If information is missing/unknown, code as ‘3’
1=Yes
2=No
3=Unknown

45

P1_SiteEye

Ocular site of infection
If information is missing/unknown, code as ‘3’
1=Yes
2=No
3=Unknown

46

P1_SiteSera

Blood or sera infection
If information is missing/unknown, code as ‘3’
1=Yes
2=No
3=Unknown
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47

P1_SiteJoint

Joint or synovial fluid infection
1=Yes
2=No
3=Unknown

48

P1_SiteOTH

Site of infection, not specified above
If information is missing/unknown, code as ‘3’
1=Yes
2=No
3=Unknown

49

P1_SiteUNK

All site of infection information missing for this case - use only if no
other information is available.
If the answer to any one of 40-48 above is ‘1’ or ‘2’ then this data
element should be coded ‘2’. If all data elements 40-48 are coded as
‘3’ then code this data element as ‘1’.
1=Yes
2=No

Health Department Laboratory Records
50

P1_L1_EventID

Unique identifier for associated surveillance record
Will be a primary key for merging lab and case data; should
correspond to P1_EventID. This data element cannot be ‘null’ or
contain missing values.

51

P1_L1_LabID

Unique identifier for laboratory performing testing
Site assigned; may be ID from other system or specifically created for
eSSuN. If performing lab is not known, site should still create a lab
record with a locally defined ID corresponding to unknown lab that
they will use throughout the eSSuN data collection period. This data
element cannot be ‘null’ or contain missing values.

52

P1_L1_Accession

Unique identifier (accession number) for laboratory record
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Leave blank (null) if not available/ascertained

53

P1_L1_PatientID

Unique identifier for person (allowing longitudinal tracking of persons)
Will be a secondary key for merging lab and case data; should
correspond to P1_PatientID. This data element cannot be ‘null’ or
contain missing values.

54

P1_L1_CondTested

specific condition/pathogen tested
This data element cannot be ‘null’ or contain missing values.
1=Syphilis
2=Gonorrhea
3=Chlamydia
4=Genital Herpes
5=Trichomoniasis
6=HIV
7=Hep A
8=Hep B
9=Hep C
10=BV
11=Other

55

P1_L1_SpecColDte

Specimen collection date - this is often used as a proxy for diagnosis
date and is important to obtain
This data element cannot be ‘null’ or contain missing values.

56

P1_L1_LabRepDte

This is the date that the performing lab reported the results to the
health department

57

P1_L1_SecType

Type of specimen
This data element cannot be ‘null’ or contain missing values.
1=Exudate
2=Blood/sera
3=Synovial fluid
4=Urine
5=CSF
6=Tissue
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7=Saliva
8=Other
9=Unknown

58

P1_L1_AnatSite

This is the anatomic site from which the specimen was obtained and is
important in determining the anatomic site of infection
This data element cannot be ‘null’ or contain missing values.
1=Urethra
2=Vagina/cervix
3=Urine
4=Rectum
5=Pharynx
6=Eye
7=Sera/Blood
8=Joint
9=Other Anatomic Site
10=Unknown Anatomic Site

59

P1_L1_TestType

As test technology advances, it is important to obtain the type of test
performed
This data element cannot be ‘null’ or contain missing values.
1=Culture,
2=NAAT
3=Non-amplified nucleic acid test/DNA probe
4=Gram Stain
5=DFA
6=Rapid HIV
7=ELISA
8=Western blot
9=Pooled RNA
10=RPR
11=VDRL
12=FTA
13=TP-PA
14=MHA
15=Wet Mount/Clue Cell
16=PH
17=Other
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18=Unknown

60

P1_L1_QualRes

Qualitative result: For most pathogens/tests, positive, negative,
equivocal and unknown
This data element cannot be ‘null’ or contain missing values.
1=Positive
2=Negative
3=Reactive
4=Weakly Reactive
5=Non-Reactive
6=Equivocal/Indeterminate
7=Specimen Inadequate/Contaminated
8=Other
9=Unknown

61

P1_L1_Quantres

Not relevant to GC/CT but may become relevant in the future or for
other pathogens of interest (default to ‘null’ value)

Health Department Provider Information
62

P2_ProvID

Unique facility/provider ID
This data element cannot be ‘null’ or contain missing values.

63

P2_ProvCO

County FIPS code for provider/facility physical location

64

P2_ProvZIP

Facility/provider physical location 5-digit ZIP

65

P2_ProvCHC

Is facility/provider a Community Health Center (CHC)?
Community Health Centers are not-for-profit primary care
organizations governed by a community board and whose primary
mission is to provide medical services to traditionally under-served
populations. The primary way of determining CHC status is by selfidentification (though some put it in their name). The National
Association of Community Health Centers (NACHC) does maintain
member lists as well. Non-profit and community board governance
are the key features.

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1=Yes
2=No
3=Unknown/Missing

66

P2_ProvFQHC

Is facility/provider a Federally Qualified Health Center (FQHC)?
Federally qualified health centers (FQHCs) include all organizations
receiving grants under Section 330 of the Public Health Service Act
(PHS). These are a matter of public record and lists are available from
HRSA
1=Yes
2=No
3=Unknown/Missing

P2_ProvPTXvisitDte

Date of patient initial visit for this issue, can be supplied/filled in from
case or laboratory report information

67

68

P2_ProvClinType

What was the category of provider examining/treating this patient (e.g.
MD, RN, ARNP, etc.?)
1=MD
2=RN
3=PA
4=ARNP
5=LPN
6=Other
7=Unknown/Not Ascertained

69

P2_ProvPTX_GenderSP

Provider documented gender of sex partners
1=Males only
2=Females only
3=Both Males and Females
4=Not Documented

70

P2_ProvPTX_Insure

Insurance status of patient from provider's records
1=Yes, Insured
2=No, Not Insured
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3=Unknown/Missing

71

P2_Urethritis

Was urethritis found on exam
Missing/unknown information code as null (‘.’).
1=Yes
2=No

72

P2_Proctitis

Was proctitis found on exam
Missing/unknown information code as null (‘.’).
1=Yes
2=No

73

P2_Epididymitis

Was epididymitis found on exam
Missing/unknown information code as null (‘.’).
1=Yes
2=No

74

P2_PID

Was PID diagnosed.
Missing/unknown information code as null (‘.’).
1=Yes
2=No

75

P2_Discharge

Was discharge found on exam
Missing/unknown information code as null (‘.’).
1=Yes
2=No

76

P2_OtherFinding

Were there other STD-related findings on exam
Missing/unknown information code as null (‘.’).
1=Yes
2=No
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77

P2_NoFinding

Were there no findings on exam
Missing/unknown information code as null (‘.’).
1=Yes
2=No

78

P2_ProvScrnUreth

Was patient screened/tested for infection at urethral site
1=Yes
2=No
3=Unknown
4=Refused

79

P2_ProvScrnVagCerv

Was patient screened/tested for infection at vaginal/cervical site
1=Yes
2=No
3=Unknown
4=Refused

80

P2_ProvScrnAnal

Was patient screened/tested for infection at anorectal site
1=Yes
2=No
3=Unknown
4=Refused

81

P2_ProvScrnPhar

Was patient screened/tested for infection at pharyngeal site
1=Yes
2=No
3=Unknown
4=Refused

82

P2_ProvScrnHIV

Was patient screened/tested for HIV infection at time of visit
1=Yes
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2=No
3=Unknown
4=Refused

83

P2_ProvPTX_TxDte

Treatment date

84

P2_ProvPTX_CFTRI

Was patient treated with ceftriaxone?
Missing/unknown information code as null (‘.’).
1=Yes
2=No

85

P2_ProvPTX_CFTRI_DS

Ceftriaxone dosage
Missing/unknown information code as null (‘.’).
1=125mg
2=250mg
3=500mg

86

P2_ProvPTX_Azit

Was patient treated with azithromycin
Missing/unknown information code as null (‘.’).
1=Yes
2=No

87

P2_ProvPTX_Azit_DS

Azithromycin dosage
Missing/unknown information code as null (‘.’).
1=1 gram
2=2 grams

88

P2_ProvPTX_Doxy

Was patient treated with doxycycline?
Missing/unknown information code as null (‘.’).
1=Yes
2=No

21
V8.0

Form Approved
OMB No. 0920-14AQA
Expiration Date ##/##/####

89

P2_ProvPTX_Cefx

Was patient treated with cefixime?
Missing/unknown information code as null (‘.’).
1=Yes
2=No

90

P2_ProvPTX_Oth

Were other medications prescribed/provided for treating GC
Missing/unknown information code as null (‘.’).
1=Yes
2=No

91 P2_ProvPTX_OtherTXT Specific other medications prescribed/provided for treating GC (text)
________________________________________
92 P2_ProvPTX_PDPT
Were any medications/prescriptions provided for patient's partner(s)?
Missing/unknown information code as null (‘.’).
1=Yes
2=No

93

P2_ProvPTX_HIBC

Was patient counseled to prevent transmission/reinfection?
Missing/unknown information code as null (‘.’).
1=Yes
2=No

94

P2_ProvPTX_Refer

Was patient referred to HD (or other) for partner services?
Missing/unknown information code as null (‘.’).
1=Yes
2=No

22
V8.0