Smallpox Questionnaires Tracking

If questionnaires are to be sent to all medical employees, it is most likely overkill to document that the questionnaire was sent. However, if you do want to document the questionnaire has been sent, follow the instructions below, but use the result code of "1", meaning "Sent". You could also use the Quick Load function in Net Health Employee Health and Occupational Medicine (if you are Hospital Employee Health users).

Once the completed questionnaire has been received back, do the following:

  1. From the Home Nav Bar click the View Chart button.

  2. Search for and select the correct employee.

  3. At the top of the [View Patient Chart] window, click the SURVEILLANCE PROFILE tab

  4. On the ACTIVITIES tab (within the Surveillance Profile), highlight the desired questionnaire, then click the Add button.

If your software is set up to force visit logging
  • At the [Log Visit or Encounter] box, click the Cancel button.

  • At the warning You are about to enter an activity without logging a visit…do you want to continue?, click Yes.

  1. In the Activity Date field, confirm the date entered is the date you received the questionnaire. If not, correct the existing date. Press the TAB key on your keyboard.

  2. Enter the result code that is appropriate to the questionnaire and result that you are documenting:

For First Responder Volunteers questionnaire, enter:

For the Fitness for vaccination questionnaire, enter:

Y if the person agreed to be a volunteer

F if the person is fit for the vaccination

R if the person refused

U if the person has contraindications for the vaccination

O if the person didn’t respond

Q if the person’s status is unclear (questionable) at present. You can later change this code when the status is clear.

  1. If needed, enter a brief summary in the Summary field, OR add a charting note. (If you add a charting note, you might add "See charting" in the Questionnaire Summary field.

  2. Click OK to return to the Surveillance Profile.

  3. Click Close to close the window.

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