HIPC Medical History Questionnaire
The HIPC Clinical Subcommittee developed a questionnaire containing ~180 questions on a participant’s medical history. HIPC centers are mandated to collect this information for any new study going forward and fill it in to the best of their ability for already ongoing studies.
This page will be updated to include the latest versions of the HIPC medical history questionnaire, as well as any new modules approved by the HIPC Clinical Subcommittee. Please see below for all of the currently approved modules, both the REDCap data dictionary (which includes all modules for Tier 1, Tier 2a and Tier 2b) and the PDF questionnaires:
- HIPCProjectDatabase_DataDictionary_2024-08-23
- STIAssessment_HIPCProjectDatab
- ScdData_HIPCProjectDatabase
- Reactogenicity_HIPCProjectData
- MedicalAndObHistory_HIPCProjec
- HIPCSubstanceUseQuestionnaire_
- HIPCPhysicalActivityQuestionna
- HIPCOrganTransplantRecipients_
- HIPCDietQuestionnaire_HIPCProj
- HIPCDatabase_HIPCProjectDataba
- Demographics_HIPCProjectDataba
- DeliveryOutcomes_HIPCProjectDa
ImmPort Templates for Tier 2 Clinical Data
Tier 1 clinical data (e.g., age, sex, demographic information) is captured using the subjectsHuman template.
To allow Tier 2 type clinical data (e.g., past medical history of disease, vaccination, and medication use) to be submitted in a searchable format, ImmPort has added the assessmentpanel and assessmentcomponent templates to its set of submission templates. Both templates are required in order to submit the data from the HIPC Past Medical History questionnaire.
The “assessmentpanel” template defines the type, name, and ID of the panel, which will later be referred to in the “assessmentcomponent” template. The entire HIPC Past Medical History questionnaire represents a single panel.
assessmentpanel_example
The “assessmentcomponent” template captures the recorded response of each participant. It is designed to hold one question and its answer per row for each participant.
assessmentcomponent_example