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PRE-TRAVEL QUESTIONNAIRE Simcoe Travel Clinic 9292 Highway 93 Superstore Medical Centre, 2nd floor
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Document Date: 2013-07-29 09:37:16

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City

Midland / /

Company

Inns/ B&B Camping Company / /

Facility

PRE-TRAVEL QUESTIONNAIRE Simcoe Travel Clinic / camp Volunteer / Simcoe Travel Clinic / /

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IndustryTerm

class hotel / cancer treatment / post travel care / /

MedicalCondition

HIV / disease / active infection / Seizures / measles / e.g. cancer / Rubeola / Not Known Had Disease Meningococcal Meningitis Polio Pneumococcal Pneumonia Influenza Tetanus/ Diphtheria / appropriate box Chicken Pox / fever / Typhoid / Japanese Encephalitis Measles / Significant Medical Illness / Had Disease / Mumps Rubella / day measles / Injection Typhoid / /

MedicalTreatment

Immunization / vaccinations / Vaccination / Chemotherapy / /

Organization

Superstore Medical Centre / /

Person

Anticoagulant (Warfarin) Steroids / Chicken Pox (Varicella) / Anticonvulsant Antidepressant Anticoagulant / S. Karson / /

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Product

Septra / Penicillin / Bactrim / Prednisone / /

ProvinceOrState

Ontario / /

Technology

cellular telephone / Chemotherapy / /

SocialTag