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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> <head> <meta http-equiv="content-type" content="text/html;charset=utf-8" /> <meta http-equiv="X-UA-Compatible" content="IE=EmulateIE7" /> <script type="text/javascript" src="//code.jquery.com/jquery-1.9.0.min.js"></script> <script type="text/javascript" src="js/jquery.multi-select.js"></script> <script type="text/javascript" src="js/jquery.expander.min.js"></script> <script type="text/javascript" src="js/prep.expander.js"></script> <link rel="stylesheet" type="text/css" href="css/multi-select.css" /> <link rel="stylesheet" type="text/css" href="css/prep.css" /> <link rel="stylesheet" type="text/css" href="css/expander.css" /> <link rel="stylesheet" type="text/css" href="css/print.css" media="print" /> <title>Travel Providers’ Rapid Evaluation Portal (Pre-Travel PREP) - Travel Tools - Global TravEpiNet - A National Consortium of Travel Health Providers</title> <meta name="viewport" content="width=device-width, initial-scale=1.0, maximum-scale=1.0" /> </head> <body> <div id="top" class="pageContainer entity"> <div id="header"> <div id="headerContent"> <div id="logo"> <h1><a href="http://www.massgeneral.org/">MassGeneral Home</a></h1> </div> <div class="recNavAndSearch"> <div class="recedingNav"> <ul> <li class="recNLink"><img src="images/imgs/ico_home.gif" width="12" height="11" alt="Home" /> <a id="recNavHome" accesskey="h" href="http://www.massgeneral.org/default.aspx">Mass General Home</a> <div class="dropNavOuter"> <div class="dropNavTop"> <div class="dropNav"> <div class="dropNavInner clearfix"> <ul> <li><a accesskey="2" href="http://www.massgeneral.org/conditions/default_landing.aspx">Conditions & Treatments</a></li> <li><a accesskey="3" href="http://www.massgeneral.org/services/default.aspx">Centers & Services</a></li> <li><a accesskey="4" href="http://www.massgeneral.org/research/default.aspx">Research & Clinical Trials</a></li> </ul> <ul class="recCol2"> <li><a accesskey="5" href="http://www.massgeneral.org/education/default.aspx">Education & Training</a></li> <li><a accesskey="6" href="http://www.massgeneral.org/careers/default.aspx">Career Opportunities</a></li> <li class="last"><a accesskey="7" href="http://www.massgeneral.org/about/default.aspx">About Mass General</a></li> </ul> </div> </div> </div> </div> </li> </ul> </div> </div>  </div>  </div>  <div id="brandCanvas" class="brandCanvas mghGlobal"> <div id="brandCanvasContent"> <div class="canvasTxt"> <h2>Global TravEpiNet</h2> <h3>A National Consortium of Travel Health Providers</h3> </div> </div> </div>  </div>   <div id="mainContainer" class="clearfix"> <div id="print-container"> <div id="mainCol"> <div id="topContent"> <table width="938" border="0" cellspacing="0" cellpadding="0"> <tr>    <td valign="top"> <table border="0" cellspacing="0" cellpadding="0"> <tr> <td width="26" valign="top"></td> <td width="697" valign="top"> <div class="container"> <div class="content" dir="ltr"> <img src="images/preplogo.jpg" alt="PREP | Global TravEpiNet" title="PREP | Global TravEpiNet" id="logo" /> <h2>Pre-Travel Providers’ Rapid Evaluation Portal (Pre-Travel PREP)</h2> <p id="welcome">Welcome to Pre-travel PREP! Pre-Travel PREP is a free clinical tool that guides you through preparing a US traveler for a safe and healthy international trip. It was developed to act as an interactive <a href="https://wwwnc.cdc.gov/travel/page/yellowbook-home" target="_blank" class="cdc">Yellow Book (Health Information for International Travel)</a>, and its output is based on the recommendations of the <a href="https://wwwnc.cdc.gov/travel" target="_blank" class="cdc">US Centers for Disease Control and Prevention</a>. PREP is continuously updated as new recommendations arise. Its development is supported by the Massachusetts General Hospital and the CDC.</p> <div id="questions-page"> <form action="prep" method="POST" name="gten-prep-form" id="gten-prep-form"> <input value="en-US" id="lang" name="lang" type="hidden" /> <input name="hash" type="hidden" value="c94c083552fe9cddef02f5533fc962231654a7bebe1eb4fcbdaf0c20d69a1ae9" id="hash" /> <div class="section" id="practice"> <h3>Provider information</h3> <p class="direction">Please provide information about yourself:</p> <p class="small"><span class="required">*</span> Indicates a required question</p> <div class="question-div required" id="practitioner-question-div"> <label class="primary" for="practitioner">Which of the following best describes you?<span class="required">*</span></label> <div class="question-elements"> <select name="practitioner" id="practitioner"> <option value=""></option> <option value="pcp">Primary Care Physician</option> <option value="specialist">Specialist Physician</option> <option value="nurse">Nurse or nurse-practitioner</option> <option value="pharmacist">Pharmacist</option> <option value="other">Other practitioner</option> </select> </div> </div> <div class="question-div required" id="practype-question-div"> <label class="primary" for="practype">Which of the following best describes your type of practice?<span class="required">*</span></label> <div class="question-elements"> <select name="practype" id="practype"> <option value=""></option> <option value="private">Private office</option> <option value="hospclinic">Hospital based clinic</option> <option value="pubclinic">Public, community or health-ministry based clinic</option> <option value="univclinic">Health service of a university or college</option> <option value="milclinic">Military health clinic</option> <option value="other">Other</option> </select> </div> </div> <div class="question-div" id="uszip-question-div"> <label class="primary" for="uszip">Please provide your US ZIP code (use "99999" if not in US):<span class="required">*</span></label> <div class="question-elements"> <input id="uszip" size="7" value="" type="text" name="uszip" /> </div> </div> <div class="question-div" id="praccountry-question-div"> <label class="primary" for="praccountry">If you do not practice in the U.S., please select your country:</label> <div class="question-elements"> <select name="praccountry" id="praccountry"><option value=""></option><option value="afghanistan">Afghanistan</option><option value="albania">Albania</option><option value="algeria">Algeria</option><option value="american-samoa">American Samoa</option><option value="andorra">Andorra</option><option value="anegada">Anegada</option><option value="angola">Angola</option><option value="anguilla">Anguilla (U.K.)</option><option value="antarctica">Antarctica</option><option value="antigua-and-barbuda">Antigua and Barbuda</option><option value="argentina">Argentina</option><option value="armenia">Armenia</option><option value="aruba">Aruba</option><option value="australia">Australia</option><option value="austral-islands">Austral Islands</option><option value="austria">Austria</option><option value="azerbaijan">Azerbaijan</option><option value="azores">Azores</option><option value="the-bahamas">Bahamas, The</option><option value="bahrain">Bahrain</option><option value="bangladesh">Bangladesh</option><option value="barbados">Barbados</option><option value="barbuda">Barbuda</option><option value="belarus">Belarus</option><option value="belgium">Belgium</option><option value="belize">Belize</option><option value="benin">Benin</option><option value="bermuda">Bermuda (U.K.)</option><option value="bhutan">Bhutan</option><option value="bolivia">Bolivia</option><option value="bonaire">Bonaire</option><option value="bora-bora">Bora-Bora</option><option value="bosnia-and-herzegovina">Bosnia and Herzegovina</option><option value="botswana">Botswana</option><option value="brazil">Brazil</option><option value="british-indian-ocean-territory">British Indian Ocean Territory (U.K.)</option><option value="brunei">Brunei</option><option value="bulgaria">Bulgaria</option><option value="burkina-faso">Burkina Faso</option><option value="burma">Burma (Myanmar)</option><option value="burundi">Burundi</option><option value="caicos-islands">Caicos Islands</option><option value="cambodia">Cambodia</option><option value="cameroon">Cameroon</option><option value="canada">Canada</option><option value="canary-islands">Canary Islands (Spain)</option><option value="cape-verde">Cape Verde</option><option value="cayman-islands">Cayman Islands (U.K.)</option><option value="central-african-republic">Central African Republic</option><option value="chad">Chad</option><option value="chile">Chile</option><option value="china">China</option><option value="christmas-island">Christmas Island (Australia)</option><option value="cocos-islands">Cocos (Keeling) Islands (Australia)</option><option value="colombia">Colombia</option><option value="comoros">Comoros</option><option value="congo">Congo, Republic of the</option><option value="cook-islands">Cook Islands (New Zealand)</option><option value="costa-rica">Costa Rica</option><option value="ivory-coast">Côte d'Ivoire</option><option value="croatia">Croatia</option><option value="cuba">Cuba</option><option value="curacao">Curaçao</option><option value="cyprus">Cyprus</option><option value="czech-republic">Czech Republic</option><option value="democratic-republic-of-congo">Democratic Republic of the Congo</option><option value="denmark">Denmark</option><option value="djibouti">Djibouti</option><option value="dominica">Dominica</option><option value="dominican-republic">Dominican Republic</option><option value="dubai">Dubai</option><option value="easter-island">Easter Island (Chile)</option><option value="ecuador">Ecuador</option><option value="egypt">Egypt</option><option value="el-salvador">El Salvador</option><option value="england">England</option><option value="equatorial-guinea">Equatorial Guinea</option><option value="eritrea">Eritrea</option><option value="estonia">Estonia</option><option value="ethiopia">Ethiopia</option><option value="falkland-islands">Falkland Islands (Islas Malvinas)</option><option value="faroe-island">Faroe Islands (Denmark)</option><option value="fiji">Fiji</option><option value="finland">Finland</option><option value="france">France</option><option value="french-guiana">French Guiana (France)</option><option value="french-polynesia">French Polynesia (France)</option><option value="gabon">Gabon</option><option value="galapagos-islands">Galápagos Islands</option><option value="the-gambia">Gambia, The</option><option value="georgia">Georgia</option><option value="germany">Germany</option><option value="ghana">Ghana</option><option value="gibraltar">Gibraltar (U.K.)</option><option value="greece">Greece</option><option value="greenland">Greenland (Denmark)</option><option value="grenada">Grenada</option><option value="grenadines">Grenadines</option><option value="guadeloupe">Guadeloupe</option><option value="guam">Guam (U.S.)</option><option value="guatemala">Guatemala</option><option value="guernsey">Guernsey</option><option value="guinea">Guinea</option><option value="guinea-bissau">Guinea-Bissau</option><option value="guyana">Guyana</option><option value="haiti">Haiti</option><option value="holy-see">Holy See</option><option value="honduras">Honduras</option><option value="hong-kong-sar">Hong Kong SAR (China)</option><option value="hungary">Hungary</option><option value="iceland">Iceland</option><option value="india">India</option><option value="indonesia">Indonesia</option><option value="iran">Iran</option><option value="iraq">Iraq</option><option value="ireland">Ireland</option><option value="isle-of-man">Isle of Man</option><option value="israel">Israel (including the West Bank and Gaza)</option><option value="italy">Italy</option><option value="jamaica">Jamaica</option><option value="japan">Japan</option><option value="jersey">Jersey</option><option value="jordan">Jordan</option><option value="jost-van-dyke">Jost Van Dyke</option><option value="kazakhstan">Kazakhstan</option><option value="kenya">Kenya</option><option value="kiribati">Kiribati</option><option value="kosovo">Kosovo</option><option value="kuwait">Kuwait</option><option value="kyrgyzstan">Kyrgyzstan</option><option value="laos">Laos</option><option value="latvia">Latvia</option><option value="lebanon">Lebanon</option><option value="lesotho">Lesotho</option><option value="liberia">Liberia</option><option value="libya">Libya</option><option value="liechtenstein">Liechtenstein</option><option value="lithuania">Lithuania</option><option value="luxembourg">Luxembourg</option><option value="macau-sar">Macau SAR (China)</option><option value="macedonia">Macedonia</option><option value="madagascar">Madagascar</option><option value="maderia-islands">Madeira Islands (Portugal)</option><option value="malawi">Malawi</option><option value="malaysia">Malaysia</option><option value="maldives">Maldives</option><option value="mali">Mali</option><option value="malta">Malta</option><option value="marquesas-islands">Marquesas Islands</option><option value="marshall-islands">Marshall Islands</option><option value="martinique">Martinique (France)</option><option value="mauritania">Mauritania</option><option value="mauritius">Mauritius</option><option value="mayotte">Mayotte (France)</option><option value="mexico">Mexico</option><option value="micronesia">Micronesia, Federated States of</option><option value="moldova">Moldova</option><option value="monaco">Monaco</option><option value="mongolia">Mongolia</option><option value="montenegro">Montenegro</option><option value="montserrat">Montserrat (U.K.)</option><option value="moorea">Moorea</option><option value="morocco">Morocco</option><option value="mozambique">Mozambique</option><option value="namibia">Namibia</option><option value="nauru">Nauru</option><option value="nepal">Nepal</option><option value="netherlands">Netherlands, The</option><option value="new-caledonia">New Caledonia (France)</option><option value="new-zealand">New Zealand</option><option value="nicaragua">Nicaragua</option><option value="niger">Niger</option><option value="nigeria">Nigeria</option><option value="niue">Niue (New Zealand)</option><option value="norfolk-island">Norfolk Island (Australia)</option><option value="northern-ireland">Northern Ireland</option><option value="northern-mariana-islands">Northern Mariana Islands (U.S.)</option><option value="north-korea">North Korea</option><option value="norway">Norway</option><option value="oman">Oman</option><option value="pakistan">Pakistan</option><option value="palau">Palau</option><option value="panama">Panama</option><option value="papua-new-guinea">Papua New Guinea</option><option value="paraguay">Paraguay</option><option value="peru">Peru</option><option value="philippines">Philippines</option><option value="pitcairn-islands">Pitcairn Islands (U.K.)</option><option value="poland">Poland</option><option value="portugal">Portugal</option><option value="puerto-rico">Puerto Rico (U.S.)</option><option value="qatar">Qatar</option><option value="reunion">Réunion (France)</option><option value="romania">Romania</option><option value="rota">Rota</option><option value="rurutu">Rurutu</option><option value="russia">Russia</option><option value="rwanda">Rwanda</option><option value="saba">Saba</option><option value="saint-barthelemy">Saint Barthelemy</option><option value="saint-croix">Saint Croix</option><option value="saint-helena">Saint Helena (U.K.)</option><option value="saint-john">Saint John</option><option value="st-kitts-and-nevis">Saint Kitts and Nevis</option><option value="saint-lucia">Saint Lucia</option><option value="saint-martin">Saint Martin</option><option value="saint-pierre-and-miquelon">Saint Pierre and Miquelon (France)</option><option value="saint-thomas">Saint Thomas</option><option value="saint-vincent-and-the-grenadines">Saint Vincent and the Grenadines</option><option value="saipan">Saipan</option><option value="samoa">Samoa</option><option value="san-marino">San Marino</option><option value="sao-tome-and-principe">São Tomé and Príncipe</option><option value="saudi-arabia">Saudi Arabia</option><option value="scotland">Scotland</option><option value="senegal">Senegal</option><option value="serbia">Serbia</option><option value="seychelles">Seychelles</option><option value="sierra-leone">Sierra Leone</option><option value="singapore">Singapore</option><option value="sint-eustatius">Sint Eustatius</option><option value="sint-maarten">Sint Maarten</option><option value="slovakia">Slovakia</option><option value="slovenia">Slovenia</option><option value="society-islands">Society Islands</option><option value="solomon-islands">Solomon Islands</option><option value="somalia">Somalia</option><option value="south-africa">South Africa</option><option value="south-georgia-south-sandwich-islands">South Georgia and the South Sandwich Islands (U.K.)</option><option value="south-korea">South Korea</option><option value="south-sandwich-islands">South Sandwich Islands</option><option value="south-sudan">South Sudan</option><option value="spain">Spain</option><option value="sri-lanka">Sri Lanka</option><option value="sudan">Sudan</option><option value="suriname">Suriname</option><option value="swaziland">Swaziland</option><option value="sweden">Sweden</option><option value="switzerland">Switzerland</option><option value="syria">Syria</option><option value="tahiti">Tahiti</option><option value="taiwan">Taiwan</option><option value="tajikistan">Tajikistan</option><option value="tanzania">Tanzania</option><option value="thailand">Thailand</option><option value="east-timor">Timor-Leste (East Timor)</option><option value="tinian">Tinian</option><option value="tobago">Tobago</option><option value="togo">Togo</option><option value="tokelau">Tokelau (New Zealand)</option><option value="tonga">Tonga</option><option value="tortola">Tortola</option><option value="trinidad-and-tobago">Trinidad and Tobago</option><option value="tubuai">Tubuai</option><option value="tunisia">Tunisia</option><option value="turkey">Turkey</option><option value="turkmenistan">Turkmenistan</option><option value="turks-and-caicos">Turks and Caicos Islands (U.K.)</option><option value="tuvalu">Tuvalu</option><option value="uganda">Uganda</option><option value="ukraine">Ukraine</option><option value="united-arab-emirates">United Arab Emirates</option><option value="united-kingdom">United Kingdom</option><option value="united-states">United States</option><option value="uruguay">Uruguay</option><option value="uzbekistan">Uzbekistan</option><option value="vanuatu">Vanuatu</option><option value="vatican-city">Vatican City</option><option value="venezuela">Venezuela</option><option value="vietnam">Vietnam</option><option value="virgin-gorda">Virgin Gorda</option><option value="british-virgin-islands">Virgin Islands, British</option><option value="usvirgin-islands">Virgin Islands, U.S.</option><option value="wake-island">Wake Island</option><option value="wales">Wales</option><option value="western-sahara">Western Sahara</option><option value="yemen">Yemen</option><option value="zambia">Zambia</option><option value="zanzibar">Zanzibar</option><option value="zimbabwe">Zimbabwe</option></select> </div> </div> <div class="question-div" id="usecookies-question-div"> <label><input name="usecookies" type="checkbox" value="1" id="usecookies" /> Use a cookie to store the previous answers</label> </div> </div> <div class="section" id="traveler"> <h3>Traveler information</h3> <p class="direction">Please provide information about the traveler:</p> <div class="question-div required" id="age-question-div"> <label class="primary" for="age_y">How old is the traveler?<span class="required">*</span></label> <div class="question-elements"> <input type="text" name="age_y" value="" size="4" id="age_y" /> years <label for="age_m">(for children < 1 year, please enter age in months:</label> <input type="text" name="age_m" id="age_m" value="" size="4" /> months) </div> </div> <div class="question-div required" id="sex-question-div"> <label class="primary" for="sex">What is the traveler’s sex?<span class="required">*</span></label> <div class="question-elements"> <input id="sex_male" value="male" type="radio" name="sex" /> <label for="sex_male">Male</label> <input value="female" id="sex_female" type="radio" name="sex" /> <label for="sex_female">Female</label> </div> </div> <div class="question-div required" id="dests-question-div"> <label class="primary" for="destinations">Where is the traveler going?<span class="required">*</span></label> <div class="question-elements"> <select name="dests" id="dests" size="15" multiple="multiple"><option value="afghanistan">Afghanistan</option><option value="albania">Albania</option><option value="algeria">Algeria</option><option value="american-samoa">American Samoa</option><option value="andorra">Andorra</option><option value="anegada">Anegada</option><option value="angola">Angola</option><option value="anguilla">Anguilla (U.K.)</option><option value="antarctica">Antarctica</option><option value="antigua-and-barbuda">Antigua and Barbuda</option><option value="argentina">Argentina</option><option value="armenia">Armenia</option><option value="aruba">Aruba</option><option value="australia">Australia</option><option value="austral-islands">Austral Islands</option><option value="austria">Austria</option><option value="azerbaijan">Azerbaijan</option><option value="azores">Azores</option><option value="the-bahamas">Bahamas, The</option><option value="bahrain">Bahrain</option><option value="bangladesh">Bangladesh</option><option value="barbados">Barbados</option><option value="barbuda">Barbuda</option><option value="belarus">Belarus</option><option value="belgium">Belgium</option><option value="belize">Belize</option><option value="benin">Benin</option><option value="bermuda">Bermuda (U.K.)</option><option value="bhutan">Bhutan</option><option value="bolivia">Bolivia</option><option value="bonaire">Bonaire</option><option value="bora-bora">Bora-Bora</option><option value="bosnia-and-herzegovina">Bosnia and Herzegovina</option><option value="botswana">Botswana</option><option value="brazil">Brazil</option><option value="british-indian-ocean-territory">British Indian Ocean Territory (U.K.)</option><option value="brunei">Brunei</option><option value="bulgaria">Bulgaria</option><option value="burkina-faso">Burkina Faso</option><option value="burma">Burma (Myanmar)</option><option value="burundi">Burundi</option><option value="caicos-islands">Caicos Islands</option><option value="cambodia">Cambodia</option><option value="cameroon">Cameroon</option><option value="canada">Canada</option><option value="canary-islands">Canary Islands (Spain)</option><option value="cape-verde">Cape Verde</option><option value="cayman-islands">Cayman Islands (U.K.)</option><option value="central-african-republic">Central African Republic</option><option value="chad">Chad</option><option value="chile">Chile</option><option value="china">China</option><option value="christmas-island">Christmas Island (Australia)</option><option value="cocos-islands">Cocos (Keeling) Islands (Australia)</option><option value="colombia">Colombia</option><option value="comoros">Comoros</option><option value="congo">Congo, Republic of the</option><option value="cook-islands">Cook Islands (New Zealand)</option><option value="costa-rica">Costa Rica</option><option value="ivory-coast">Côte d'Ivoire</option><option value="croatia">Croatia</option><option value="cuba">Cuba</option><option value="curacao">Curaçao</option><option value="cyprus">Cyprus</option><option value="czech-republic">Czech Republic</option><option value="democratic-republic-of-congo">Democratic Republic of the Congo</option><option value="denmark">Denmark</option><option value="djibouti">Djibouti</option><option value="dominica">Dominica</option><option value="dominican-republic">Dominican Republic</option><option value="dubai">Dubai</option><option value="easter-island">Easter Island (Chile)</option><option value="ecuador">Ecuador</option><option value="egypt">Egypt</option><option value="el-salvador">El Salvador</option><option value="england">England</option><option value="equatorial-guinea">Equatorial Guinea</option><option value="eritrea">Eritrea</option><option value="estonia">Estonia</option><option value="ethiopia">Ethiopia</option><option value="falkland-islands">Falkland Islands (Islas Malvinas)</option><option value="faroe-island">Faroe Islands (Denmark)</option><option value="fiji">Fiji</option><option value="finland">Finland</option><option value="france">France</option><option value="french-guiana">French Guiana (France)</option><option value="french-polynesia">French Polynesia (France)</option><option value="gabon">Gabon</option><option value="galapagos-islands">Galápagos Islands</option><option value="the-gambia">Gambia, The</option><option value="georgia">Georgia</option><option value="germany">Germany</option><option value="ghana">Ghana</option><option value="gibraltar">Gibraltar (U.K.)</option><option value="greece">Greece</option><option value="greenland">Greenland (Denmark)</option><option value="grenada">Grenada</option><option value="grenadines">Grenadines</option><option value="guadeloupe">Guadeloupe</option><option value="guam">Guam (U.S.)</option><option value="guatemala">Guatemala</option><option value="guernsey">Guernsey</option><option value="guinea">Guinea</option><option value="guinea-bissau">Guinea-Bissau</option><option value="guyana">Guyana</option><option value="haiti">Haiti</option><option value="holy-see">Holy See</option><option value="honduras">Honduras</option><option value="hong-kong-sar">Hong Kong SAR (China)</option><option value="hungary">Hungary</option><option value="iceland">Iceland</option><option value="india">India</option><option value="indonesia">Indonesia</option><option value="iran">Iran</option><option value="iraq">Iraq</option><option value="ireland">Ireland</option><option value="isle-of-man">Isle of Man</option><option value="israel">Israel (including the West Bank and Gaza)</option><option value="italy">Italy</option><option value="jamaica">Jamaica</option><option value="japan">Japan</option><option value="jersey">Jersey</option><option value="jordan">Jordan</option><option value="jost-van-dyke">Jost Van Dyke</option><option value="kazakhstan">Kazakhstan</option><option value="kenya">Kenya</option><option value="kiribati">Kiribati</option><option value="kosovo">Kosovo</option><option value="kuwait">Kuwait</option><option value="kyrgyzstan">Kyrgyzstan</option><option value="laos">Laos</option><option value="latvia">Latvia</option><option value="lebanon">Lebanon</option><option value="lesotho">Lesotho</option><option value="liberia">Liberia</option><option value="libya">Libya</option><option value="liechtenstein">Liechtenstein</option><option value="lithuania">Lithuania</option><option value="luxembourg">Luxembourg</option><option value="macau-sar">Macau SAR (China)</option><option value="macedonia">Macedonia</option><option value="madagascar">Madagascar</option><option value="maderia-islands">Madeira Islands (Portugal)</option><option value="malawi">Malawi</option><option value="malaysia">Malaysia</option><option value="maldives">Maldives</option><option value="mali">Mali</option><option value="malta">Malta</option><option value="marquesas-islands">Marquesas Islands</option><option value="marshall-islands">Marshall Islands</option><option value="martinique">Martinique (France)</option><option value="mauritania">Mauritania</option><option value="mauritius">Mauritius</option><option value="mayotte">Mayotte (France)</option><option value="mexico">Mexico</option><option value="micronesia">Micronesia, Federated States of</option><option value="moldova">Moldova</option><option value="monaco">Monaco</option><option value="mongolia">Mongolia</option><option value="montenegro">Montenegro</option><option value="montserrat">Montserrat (U.K.)</option><option value="moorea">Moorea</option><option value="morocco">Morocco</option><option value="mozambique">Mozambique</option><option value="namibia">Namibia</option><option value="nauru">Nauru</option><option value="nepal">Nepal</option><option value="netherlands">Netherlands, The</option><option value="new-caledonia">New Caledonia (France)</option><option value="new-zealand">New Zealand</option><option value="nicaragua">Nicaragua</option><option value="niger">Niger</option><option value="nigeria">Nigeria</option><option value="niue">Niue (New Zealand)</option><option value="norfolk-island">Norfolk Island (Australia)</option><option value="northern-ireland">Northern Ireland</option><option value="northern-mariana-islands">Northern Mariana Islands (U.S.)</option><option value="north-korea">North Korea</option><option value="norway">Norway</option><option value="oman">Oman</option><option value="pakistan">Pakistan</option><option value="palau">Palau</option><option value="panama">Panama</option><option value="papua-new-guinea">Papua New Guinea</option><option value="paraguay">Paraguay</option><option value="peru">Peru</option><option value="philippines">Philippines</option><option value="pitcairn-islands">Pitcairn Islands (U.K.)</option><option value="poland">Poland</option><option value="portugal">Portugal</option><option value="puerto-rico">Puerto Rico (U.S.)</option><option value="qatar">Qatar</option><option value="reunion">Réunion (France)</option><option value="romania">Romania</option><option value="rota">Rota</option><option value="rurutu">Rurutu</option><option value="russia">Russia</option><option value="rwanda">Rwanda</option><option value="saba">Saba</option><option value="saint-barthelemy">Saint Barthelemy</option><option value="saint-croix">Saint Croix</option><option value="saint-helena">Saint Helena (U.K.)</option><option value="saint-john">Saint John</option><option value="st-kitts-and-nevis">Saint Kitts and Nevis</option><option value="saint-lucia">Saint Lucia</option><option value="saint-martin">Saint Martin</option><option value="saint-pierre-and-miquelon">Saint Pierre and Miquelon (France)</option><option value="saint-thomas">Saint Thomas</option><option value="saint-vincent-and-the-grenadines">Saint Vincent and the Grenadines</option><option value="saipan">Saipan</option><option value="samoa">Samoa</option><option value="san-marino">San Marino</option><option value="sao-tome-and-principe">São Tomé and Príncipe</option><option value="saudi-arabia">Saudi Arabia</option><option value="scotland">Scotland</option><option value="senegal">Senegal</option><option value="serbia">Serbia</option><option value="seychelles">Seychelles</option><option value="sierra-leone">Sierra Leone</option><option value="singapore">Singapore</option><option value="sint-eustatius">Sint Eustatius</option><option value="sint-maarten">Sint Maarten</option><option value="slovakia">Slovakia</option><option value="slovenia">Slovenia</option><option value="society-islands">Society Islands</option><option value="solomon-islands">Solomon Islands</option><option value="somalia">Somalia</option><option value="south-africa">South Africa</option><option value="south-georgia-south-sandwich-islands">South Georgia and the South Sandwich Islands (U.K.)</option><option value="south-korea">South Korea</option><option value="south-sandwich-islands">South Sandwich Islands</option><option value="south-sudan">South Sudan</option><option value="spain">Spain</option><option value="sri-lanka">Sri Lanka</option><option value="sudan">Sudan</option><option value="suriname">Suriname</option><option value="swaziland">Swaziland</option><option value="sweden">Sweden</option><option value="switzerland">Switzerland</option><option value="syria">Syria</option><option value="tahiti">Tahiti</option><option value="taiwan">Taiwan</option><option value="tajikistan">Tajikistan</option><option value="tanzania">Tanzania</option><option value="thailand">Thailand</option><option value="east-timor">Timor-Leste (East Timor)</option><option value="tinian">Tinian</option><option value="tobago">Tobago</option><option value="togo">Togo</option><option value="tokelau">Tokelau (New Zealand)</option><option value="tonga">Tonga</option><option value="tortola">Tortola</option><option value="trinidad-and-tobago">Trinidad and Tobago</option><option value="tubuai">Tubuai</option><option value="tunisia">Tunisia</option><option value="turkey">Turkey</option><option value="turkmenistan">Turkmenistan</option><option value="turks-and-caicos">Turks and Caicos Islands (U.K.)</option><option value="tuvalu">Tuvalu</option><option value="uganda">Uganda</option><option value="ukraine">Ukraine</option><option value="united-arab-emirates">United Arab Emirates</option><option value="united-kingdom">United Kingdom</option><option value="united-states">United States</option><option value="uruguay">Uruguay</option><option value="uzbekistan">Uzbekistan</option><option value="vanuatu">Vanuatu</option><option value="vatican-city">Vatican City</option><option value="venezuela">Venezuela</option><option value="vietnam">Vietnam</option><option value="virgin-gorda">Virgin Gorda</option><option value="british-virgin-islands">Virgin Islands, British</option><option value="usvirgin-islands">Virgin Islands, U.S.</option><option value="wake-island">Wake Island</option><option value="wales">Wales</option><option value="western-sahara">Western Sahara</option><option value="yemen">Yemen</option><option value="zambia">Zambia</option><option value="zanzibar">Zanzibar</option><option value="zimbabwe">Zimbabwe</option></select> </div> <script type="text/javascript"> (function ($) { $(document).ready(function () { $("#dests").multiSelect(); }); })(jQuery); </script> </div> <div class="question-div" id="traveler-category-div"> <label class="primary" for="traveler-category">Please indicate if the traveler fits into any of the following categories (select all that apply):</label> <div class="question-elements"> <table id="traveler-category"> <tr><td class="checkbox"><input id="traveler-category_vfr" value="vfr" type="checkbox" name="traveler-category" /></td><td class="label"><label for="traveler-category_vfr">Returning home to visit family or friends (VFR)</label></td></tr> <tr><td class="checkbox"><input value="student" id="traveler-category_student" type="checkbox" name="traveler-category" /></td><td class="label"><label for="traveler-category_student">Study abroad / student traveler</label></td></tr> <tr><td class="checkbox"><input name="traveler-category" type="checkbox" id="traveler-category_aidworker" value="aidworker" /></td><td class="label"><label for="traveler-category_aidworker">Humanitarian aid or health care worker</label></td></tr> <tr><td class="checkbox"><input id="traveler-category_cruiseship" value="cruiseship" type="checkbox" name="traveler-category" /></td><td class="label"><label for="traveler-category_cruiseship">Cruise ship passenger</label></td></tr> <tr><td class="checkbox"><input id="traveler-category_expat" value="expat" type="checkbox" name="traveler-category" /></td><td class="label"><label for="traveler-category_expat">Long-term traveler or expatriate</label></td></tr> <tr><td class="checkbox"><input id="traveler-category_lastmin" value="lastmin" type="checkbox" name="traveler-category" /></td><td class="label"><label for="traveler-category_lastmin">Last minute traveler</label></td></tr> <tr><td class="checkbox"><input id="traveler-category_massgath" value="massgath" type="checkbox" name="traveler-category" /></td><td class="label"><label for="traveler-category_massgath">Traveling to a mass gathering</label></td></tr> </table> </div> </div> <div class="question-div" id="conditions-question-div"> <label class="primary" for="conditions">Please indicate if the traveler has any of the following medical problems or conditions (select all that apply):</label> <div class="question-elements"> <table id="conditions"> <tr><td class="checkbox"><input name="conditions" type="checkbox" value="egg" id="conditions_egg" /></td><td class="label"><label for="conditions_egg">Severe egg allergy (i.e. documented IgE-mediated hypersensitivity to eggs; or hives, swelling of the lips or tongue, acute respiratory distress or collapse after eating eggs)</label></td></tr> <tr><td class="checkbox"><input value="thymus" id="conditions_thymus" type="checkbox" name="conditions" /></td><td class="label"><label for="conditions_thymus">Thymus disease or history of thymectomy</label></td></tr> <tr><td class="checkbox"><input id="conditions_immune" value="immune" type="checkbox" name="conditions" /></td><td class="label"><label for="conditions_immune">Immune system disorder, or taking immune-suppressing medication (see also: <a target="_blank" class="cdc" href="https://wwwnc.cdc.gov/travel/yellowbook/2018/advising-travelers-with-specific-needs/immunocompromised-travelers" target="_blank" class="cdc">Medical Conditions and Treatments Associated with Immune Deficits</a>)</label></td></tr> <tr><td class="checkbox"><input name="conditions" type="checkbox" value="neuro" id="conditions_neuro" /></td><td class="label"><label for="conditions_neuro">Neuropsychiatric condition</label></td></tr> <tr><td class="checkbox"><input value="seizure" id="conditions_seizure" name="conditions" type="checkbox" /></td><td class="label"><label for="conditions_seizure">Seizure disorder</label></td></tr> <tr><td class="checkbox"><input type="checkbox" name="conditions" id="conditions_heart" value="heart" /></td><td class="label"><label for="conditions_heart">Heart conduction abnormality</label></td></tr> <tr><td class="checkbox"><input type="checkbox" name="conditions" value="psoriasis" id="conditions_psoriasis" /></td><td class="label"><label for="conditions_psoriasis">Psoriasis</label></td></tr> <tr><td class="checkbox"><input type="checkbox" name="conditions" id="conditions_renal" value="renal" /></td><td class="label"><label for="conditions_renal">Severe renal impairment</label></td></tr> <tr><td class="checkbox"><input type="checkbox" name="conditions" value="liver" id="conditions_liver" /></td><td class="label"><label for="conditions_liver">Chronic liver disease</label></td></tr> <tr><td class="checkbox"><input type="checkbox" name="conditions" value="pregnant" id="conditions_pregnant" /></td><td class="label"><label for="conditions_pregnant">Pregnant</label></td></tr> <tr><td class="checkbox"><input type="checkbox" name="conditions" id="conditions_planpreg" value="planpreg" /></td><td class="label"><label for="conditions_planpreg">Planning pregnancy in next three months</label></td></tr> <tr><td class="checkbox"><input id="conditions_breastfeeding" value="breastfeeding" name="conditions" type="checkbox" /></td><td class="label"><label for="conditions_breastfeeding">Breastfeeding</label></td></tr> </table> </div> </div> </div> <div class="section" id="submit"> <button type="submit" name="submit" value="submitted" id="submit-button" class="button"="submitbtn">View recommendations</button> </div> <div class="section" id="funding-note"> <p>Please let us know if you have suggestions or comments by <a href="mailto:globaltravepinet@partners.org">email</a>.</p> <p>This tool is provided by the Massachusetts General Hospital and supported by funding from grant U01CK000175 of the U.S. Centers for Disease Control and Prevention (CDC). This software is a reference tool intended to be used as an adjunct to the management of clinical care. The healthcare professional must review and verify information obtained by using the software to ensure that the information is accurate, complete and correctly associated with, and relevant to, individual cases. The tool should not be used to replace, overrule, or substitute the healthcare professional’s medical judgment, diagnosis, or treatment decisions. By using this tool, you agree that the Massachusetts General Hospital and the tool’s developers and supporters are not liable for any adverse outcomes, including those relating to your patient’s travel.</p> </div> </form> </div> </div> </div> </div> </td> </tr> </table> </td> </tr> </table> <div id="mobile-footer"> <img src="images/trhip-footer.jpg" alt="go to the GlobalTravEpiNet home page" usemap="#Map" title="go to the GlobalTravEpiNet home page" border="0" /> <map name="Map" id="Map"> <area shape="rect" coords="8,7,65,28" href="http://www.massgeneral.org/notices/privacy.aspx" alt="Privacy" /> <area shape="rect" coords="77,5,149,30" href="http://www.massgeneral.org/notices/disclaimer.aspx" alt="Disclaimer" /> <area shape="rect" coords="160,5,222,30" href="mailto:globaltravepinet@partners.org" alt="Contact" /> </map> </div> </div>  </div>  </div>  </div>     <div class="footer"> <div class="innerW"> <div class="clearfix"> <div class="col1" style="width: 400px;"> <ul> <li><a href="http://intranet.massgeneral.org/" title="Intranet">Intranet</a></li> <li><a href="http://www.massgeneral.org/notices/billinginsurance.aspx" title="Billing & Insurance">Billing & Insurance</a></li> <li><a href="http://www.massgeneral.org/notices/medicalrecords.aspx" title="nsurance">Medical Records</a></li> <li><a href="http://www.massgeneral.org/accessibility/default.aspx" class="accessibility" title="Accessibility">Accessibility</a></li>  </ul> <ul> <li><a href="http://www.massgeneral.org/notices/rights.aspx" title="Your Rights and Concerns">Your Rights & Concerns</a></li> <li><a href="http://www.massgeneral.org/notices/privacy.aspx" title="Privacy and Security">Privacy & Security</a></li> <li><a href="http://www.massgeneral.org/notices/disclaimer.aspx" title="Disclaimer">Disclaimer</a></li> <li><a href="http://www.massgeneral.org/notices/socialmediapolicy.aspx" title="Social Media Policy">Social Media Policy</a></li> </ul> <div style="clear: both;"> </div> <div class="copyR" style="margin-top: 39px;"> <ul class="clearfix" style="float: none; margin-right: 0px;"> <li class="last" style="margin-left:0px; padding-left: 0px;">© <script language="JavaScript" type="text/javascript"> document.write((new Date()).getFullYear()); </script> Massachusetts General Hospital</li> </ul> <ul class="clearfix" style="float: none; margin-right: 0px; margin-top: 8px;"> <li class="first">55 Fruit Street, Boston, MA 02114</li> <li class="last"><a href="http://www.massgeneral.org/visit/directions/default.aspx" title="Maps and Directions">Maps & Directions</a></li> </ul> <ul class="clearfix" style="float: none; margin-top: 8px;"> <li class="first">617-726-2000</li> <li class="last">TDD: 617-724-8800</li> </ul> <p style="margin-top: 8px;"> <a href="http://www.massgeneral.org/notices/sitemap.aspx" title="Site Map">Site Map</a> </p> </div> </div> <div class="col2" style="height: 144px; width: 573px; padding-top:24px;"> <ul> <li style="height: auto;"> <a href="http://www.massgeneral.org/partners.aspx"><img src="images/logos/logo_partners_medical.gif" width="200" height="34" alt="Partners Healthcare" /></a> </li> <li style="height: auto;"> <a href="http://www.massgeneral.org/harvard.aspx"><img src="images/logos/logo_harvard_medical.gif" width="143" height="40" alt="Harvard Medical School" /></a> </li> <li class="last" style="margin: 0px; height: auto;"> <a href="http://www.massgeneral.org/mgpo/"><img src="images/logos/logo_mgpo.gif" alt="Massachusetts General Physicians Organization" /></a> </li> <li class="first-add-row" style="clear:left; height: auto; margin-top: 20px;"> <a href="http://www.massgeneral.org/mghfc.aspx"><img src="images/logos/logo_mghfc.gif" width="142" height="39" alt="MassGeneral Hospital for Children" /></a> </li> <li style="height: auto; margin-top: 29px;"> <a href="http://www.massgeneral.org/give/campaignthirdcentury.aspx"><img src="images/logos/logo_campaign_third_century_wide.gif" width="193" height="72" alt="Individual Care, Global Impact: The Campaign for the Third Century of MGH Medicine" /></a> </li> <li class="last" style="margin-top: 28px;">  <a href="http://www.massgeneral.org/proto.aspx"><img src="images/logos/logo_proto.gif" alt="Proto" /></a>  </li> </ul> </div> </div> </div> </div>  <script type="text/javascript"> jQuery(document).ready(function() { jQuery(".recedingNav").mouseenter(function() { jQuery(".dropNavOuter").slideDown(); }); jQuery(".recedingNav").mouseleave(function() { jQuery(".dropNavOuter").slideUp(); }); }); </script> </body> </html>