Travel Health Consultation

1. Patient Information

2. Eligibility Screening — Medical Directive

Inclusion Criteria (must confirm all three)

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Exclusion Criteria (any checked → REFERRAL REQUIRED)

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Informed consent obtained Per Medical Directive 5.2: benefits, material risks, costs and alternatives discussed; patient advised the service is provided under the medical directive and that it does not establish a primary care relationship with the authorizing physician. All of this prints on the note with the consultation date.

3. Medical History & Allergies

These drive the malaria and altitude assessments in Section 8. Leave unchecked if not applicable.

4. Immunization History

Routine Vaccinations

Check each vaccine the patient has received and enter the most recent date.

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Travel Vaccinations — Previously Received

Record prior doses. Duration of protection guides whether a booster is needed today.

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⚠ Vaccination Gaps Identified

Select any routine gaps — these will appear in the physician note and patient summary.

Additional immunization notes

6B. Yellow Fever Screening

Complete this section only if Yellow Fever risk was identified above. Implements the 4-step algorithm per SOP Section 16.5 and Medical Directive Appendix C.

Yellow Fever screening completed for this patient Set automatically when you run the screening below. Show YF Screening ▼

7. Travel Vaccines — Plan

Check all vaccines being ordered. Auto-populated by Destination Analysis (Section 6), or select manually.

8. Travel Medications Plan

Enter the quantity to dispense for each selected medication — quantity is not calculated for you, because what is dispensed depends on the prescription, not trip length alone. The rule beneath each box comes from the clinical data file. Use the Malaria/Altitude Assessment tools below for drug selection.

First-line vs. alternate empiric treatment for TD. Not prophylactic — for use if symptoms develop.

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💡 Quantity = (lead-in days) + (trip duration) + (tail days). The exact rule for each drug is shown beneath its quantity box, read from the clinical data file.

Cost is a major concern for this patient Malarone runs $400–650 per 4 weeks; doxycycline $20–50. Influences drug choice, not eligibility.

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⚠ Dosing: 125mg BID (½ of 250mg tab, twice daily). Duration: start 1 day before ascent + full days above 2500m. Minimum 48h therapy.

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9. OTC Recommendations