0920-1072 SSuN Data Elements

[NCHHSTP] The STD Surveillance Network (SSuN)

Att5_DataElements_0920-1072_Rev2023

SSuN Gonorrhea & Syphilis Patient Interview (Random Sampling)

OMB: 0920-1072

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STD Surveillance Network (SSuN)

Revision Request



SSuN Data Elements

Attachment 5





OMB# 0920-1072



May 12, 2023








OMB Control# 0920-1072 (Expires XX/XX/XXXX)




DE #

Data Element Name

Description/Response Coding

Strategy A (STD Clinic) Data Elements

1

F1_FacilityID

Unique facility identifier



This ID should be supplied by the site and is a unique facility identifier from underlying surveillance systems or may be generated specifically for SSuN. Regardless of source, this ID must be unique and allow for longitudinal tracking of the facility. This data element MUST NOT be ‘null’ or contain missing values.




2

F1_SiteID

Unique site code






BA=Baltimore (Cycle II, Cycle III, Cycle IV)



CB=Columbus Ohio (Cycle IV)



CA=California (Cycle II, Cycle III, Cycle IV)



FL=Florida (Cycle III & Cycle IV)



IN=Indiana (Cycle IV)



MC=Multnomah County (Cycle III &Cycle IV)



NY=New York City (Cycle II, Cycle III, Cycle IV)



PH=Philadelphia (Cycle II, Cycle III, Cycle IV)



SF=San Francisco (Cycle II, Cycle III, Cycle IV)



WA=Washington (Cycle II, Cycle III, Cycle IV)



UT=UTAH (Cycle IV)



LA=Louisana (Cycle II)



VA=Virginia (Cycle II)



AL=Alabama (Cycle II)



CO=Colorado (Cycle II)



CH=Chicago (Cycle II)



MA=Massachusetts (Cycle III)



MN=Minnesota (Cycle III)



This data element MUST NOT be ‘null’ or contain missing values.




3

F1_PatientID

Unique patient identification number assigned by site



This ID should be supplied by the site and may be a unique patient identifier from underlying surveillance systems or may be generated specifically for SSuN. Regardless of source, this ID must be unique and allow for longitudinal tracking of patients within facilities. This data element MUST NOT be ‘null’ or contain missing values.




4

F1_Visdate

Date of clinic visit



This data element MUST NOT be ‘null’ or contain missing values except for HIV eHARS lab match records.




5

F1_EventID

Unique visit identification



This record ID should be supplied by the site and may be an event or visit ID assigned at the clinic level




6

F1_sex_Birth

What is the patient’s assigned sex at birth?



1= Male



2= Female



3=Intersex



4=Unknown



9=Not Captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the facility or is not provided to SSuN.




7

F1_Gender_Identity

What is the patient's gender identity?



1= Male



2= Female



3=Transgender M to F



4=Transgender F to M



5=Transgender, Unknown or Unspecified



6= Gender Queer/Non-Binary



7= Other



9= Not captured


A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected by the facility but is unknown for this record.




8

F1_Age

How old is this patient? (Age in years).



If age is unknown or missing, use null value.






For the following race/ethnic questions below: Indicate yes for all of the race/ethnic questions that apply. A response of 9 indicates the information is not captured/ collected by the facility or is not provided to SSuN. Response should be null if (1) race is collected by the facility but is unknown for this record, or (2) a response of “no” is not collected separately.

9

F1_Hisp

Is the patient of Hispanic ethnicity?



1= Yes



2= No



9= Not captured




10

F1_AIAN

Is the patient American Indian or Alaskan Native?



1= Yes



2= No



9= Not captured




11

F1_Asian

Is the patient Asian?



1= Yes



2= No



9= Not captured




12

F1_PIH

Is the patient Native Hawaiian or Pacific Islander?



1= Yes



2= No



9= Not captured




13

F1_Black

Is the patient Black?



1= Yes



2= No



9= Not captured




14

F1_White

Is the patient White?



1= Yes



2= No



9= Not captured




15

F1_Multirace

Is the patient Multirace?



1= Yes



2= No



9= Not captured




16

F1_Otherrace

Is the patient another race not listed above?



1= Yes



2= No



9= Not captured



Indicate yes for all of the race/ethnic questions that apply. A response of 9 indicates the information is not captured/ collected by the facility or is not provided to SSuN. Response should be null if (1) race is collected by the facility but is unknown for this record, or (2) a response of “no” is not collected separately.




17

F1_Insurance

What is the primary health insurance status of the patient (regardless of whether it is used for the clinic visit)?



1= Insured, Public only



2= Insured, Private only



3= Insured, Multiple types



4=Unknown type



5=Uninsured



9= Insurance status not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected but is unknown for this record.




18

F1_Visit_type

Type of clinic visit



1 = Clinician



2= express/fast track



3=Telemedicine - Clinician Visit



4=Telemedicine - Express Visit



8= Other



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or not provided to SSuN. A response of null indicates that the information is collected but is unknown for this record.




19

F1_Reason_visit

What was the primary purpose of the visit?



1= Symptomatic/new problem



2= Treatment only/Positive STD Test



3= Follow-up



4= Family planning(retired)



5= STD/HIV screening only



6= Prenatal care (retired)



7=PrEP Visit



8= Other



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. The response options 4 and 6 are no longer to be used but left here for historical purposes. Although multiple response options may be applicable to a single clinic visit, please give prescedence to the symptomatic/new problem option. A response of null indicates that the information is collected but is unknown for this record.




20

F1_Pregnant

Does the female patient self-report being currently pregnant?



1= Yes



2= No



3= Patient does not know/ not sure



9= Not captured



If information is collected but patient is not sure, then appropriate response is 3. A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values allowed for men or if information is collected by the facility but unknown for this record.




21

F1_Sympt

Did the patient present with symptoms consistent with a STI (includes genital pain, itching, dysuria, genital sores or rash, vaginal/penile/rectal discharge?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected by the facility but is unknown for this record.




22

F1_Contact_GC

Was the patient a contact to or exposed to gonorrhea?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected by the facility but is unknown for this record.




22.1

F1_Contact_CT

Was the patient a contact to or exposed to chlamydia?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected by the facility but is unknown for this record.




22.2

F1_contact_SY

Was the patient a contact to or exposed to syphilis?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected by the facility but is unknown for this record.




22.3

F1_contact_Other

Was the patient a contact or exposed to a STD (other than syphilis, chlamydia, or gonorrhea)?



1= Yes, HSV



2= Yes, MPX



3. Yes, multiple



4. Yes, don’t know specific STD



5. No, not a contact or exposed to STD



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected by the facility but is unknown for this record.




23

F1_Pelvic_exam

Was a pelvic exam performed?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values allowed for men or if information is collected by the facility but unknown for this record.




24

F1_MENSEX

In the past 3 months, how many sex partners with male genitalia does the patient report?



If number of male sex partners is unknown, missing, or not captured, use null value.




25

F1_FEMSEX

In the past 3 months, how many sex partners with female genitalia does the patient report?



If number of female sex partners is unknown, missing, or not captured, use null value.




26

F1_TRANSEX

In the past 3 months, how many sex partners reported to be transgendered does the patient report?



If number of female sex partners is unknown, missing, or not captured, use null value.




28

F1_SEXOR3

In the past 3 months, who does the patient report as sex partners?



1= Partners with male genitalia only



2= Partners with female genitalia only



3= Both



4= No Sex Partners Last 3 Mos



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected by the facility but is unknown for this record.




29

F1_SEXOR3TG

In the past 3 months, does the patient report having sex with a transgendered person (transgender man, transgender woman, or transgender unspecified)?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected by the facility but is unknown for this record.




30

F1_NUMSEX3

In the past 3 months, how many sexual partners does the patient report?



If number of sex partners is unknown, missing, or not captured, use null value.




31

F1_SEXUALITY

How does the person characterize their sexual orientation?






1= Gay/lesbian/homosexual



2= Straight/heterosexual (not Gay or Lesbian)



3= Bisexual



4= Other



9 = Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected by the facility but is unknown for this record.




32

F1_NewSex

In the last 3 months, does the patient report having a new sexual partner(s)?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the (1) information is collected by the facility but is unknown for this record or (2) that there was not an opportunity for a “no” response.




33

F1_Rectal_exposure

In the past 3 months, does the patient report receptive anal sex with a male sexual partner?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the (1) information is collected by the facility but is unknown for this record or (2) that there was not an opportunity for a “no” response.




34

F1_Oral_Sex

In the past 3 months, does the patient report oral receptive sex with a male sexual partner?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the (1) information is collected by the facility but is unknown for this record or (2) that there was not an opportunity for a “no” response.




35

F1_condom

In the past 3 months, does the patient report condomless sex (may include receptive anal or vaginal sex) with a male sexual partner?



1= Yes



2= No



3= Patient not sure/ unknown /refused



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the (1) information is collected by the facility but is unknown for this record or (2) that there was not an opportunity for a “no” response.




36

F1_HIV_partner

In the past 12 months, does the patient report having sex with a person living with HIV/AIDS?



1= Yes



2= No



3= Patient not sure/ unknown /refused



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the (1) information is collected by the facility but is unknown for this record or (2) that there was not an opportunity for a “no” response.




37

F1_IVDU

In the past 3 months, does the patient report use of illicit injected drugs?



1= Yes



2= No



3= Patient not sure/ unknown /refused



9= Not captured



If information is collected by the facility but patient is not sure, then appropriate response is 3. A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the (1) information is collected by the facility but is unknown for this record or (2) that there was not an opportunity for a “no” response.




38

F1_OPIOID

In the past 3 months, does the patient report use of opioids (but not under a physician's orders)?



1= Yes



2= No



3= Patient not sure/ unknown /refused



9= Not captured



If information is collected by the facility but patient is not sure, then appropriate response is 3. A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the (1) information is collected by the facility but is unknown for this record or (2) that there was not an opportunity for a “no” response.




38.1

F1_Prep_Scrn

Was this patient counseled and screened for PrEP eligibility?






1=Yes



2=No, Patient HIV+



3=No, Patient Refused



4=No, Express Visit Only



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value not allowed.




38.2

F1_Prep_Elig

Was this patient eligible for PrEP?






1=Yes



2=No, Patient Not Eligible (HIV+)



3=No, Patient Not Eligible (Other Reason)



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value not allowed.




38.3

F1_Prep_Ref

Was this patient referred for PrEP services?






1=Yes, Referred to in-house PrEP specialist



2=Yes, Referred to external PrEP provider



3=No, Patient Not Eligible



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value not allowed.




38.4

F1_Prep_Rx

Was this patient prescribed PrEP at this visit?






1=Yes, Initial PrEP prescription given



2=Yes, Prescription refilled



3=No, Patient not prescribed PrEP



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value not allowed.




39

F1_PrEP

Is the patient currently on PrEP?



1= Yes



2= No



3= Patient not sure/ unknown /refused



9= Not captured



If information is collected by the facility but patient is not sure, then appropriate response is 3. A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected but is unknown for this record.




40

F1_PEP_rec

Was the patient dispensed/provided HIV PEP at this STD clinic visit?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected but is unknown for this record.




41

F1_PrEP_rec

Was the patient dispensed/provided PrEP at this STD clinic visit?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. A response of null indicates that the information is collected but is unknown for this record.




41.1

F1_dPEP_Rx

Was the patient prescribed doxycycline post-exposure prophylaxis at this visit?






1=Yes



2=No



9=Not Captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value not allowed.




42

F1_Partner_tx

Was the patient prescribed or given medication for expedited partner therapy at this visit?



1= Yes



2= No



9= Not captured



A response of 9 indicates that EPT is provided by the facility, but information is not captured or collected or is not provided to SSuN. A response of null indicates that the (1) information is collected by the facility but is unknown for this record, or (2) information is collected by the facility but there is not an opportunity for a “no” response.




42.1

F1_MPOX_VaxHx

Has this patient been previously vaccinated for smallpox or mpox?






1=Yes, fully vaccinated



2=Yes, not fully vaccinated



3=No, no prior smallpox or mpox vaccination



4=Refused to provide vaccination information



9=Not captured




42.2

F1_MPOX_VaxDATE

If patient previously vaccinated for smallpox or mpox, date of most recent dose.






MM/YY



../..




42.3

F1_MPOX_Vax

Was this patient vaccinated for smallpox or mpox at this visit?






1=Yes, Administered Initial Dose



2=Yes, Administered Second Dose



3=Yes, Administered >2nd dose



4=No, no MPX vaccine administered



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value not allowed.




42.4

F1_MPOX_Vax_Spec

What smallpox or mpox vaccine was administered at this visit?






1=JYNNEOS (Imvamune or Imvanex)



2=ACAM2000



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value not allowed if F1_MPX_Vax= 1,2 or 3.




42.5

F1_MPOX_Vx_Mthd

What was the method of smallpox or mpox vaccine administration at this visit?






1=Intradermal (ID)



2=Subcutaneous (SQ)



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value not allowed if F1_MPX_Vax= 1,2 or 3.




42.6

F1_MPOX_Vx_Lot

What is the vaccine lot number of the vaccine administered at this visit?






Text



A response of 9999 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value not allowed if F1_MPX_Vax= 1,2 or 3.




42.7

F1_MPOX_Vx_dosage

What vaccine dose was administered at this visit?






#####



A response of 9999 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value not allowed if F1_MPX_Vax= 1,2 or 3.




42.8

F1_MPOX_Vx_dosUnit

What was the vaccine dose unit for the vaccine administered at this visit?






1=mL



2=CC



3=mG



4=μG (microgram)



9=Not Captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN.  Null value not allowed if F1_MPX_Vax= 1,2 or 3




43

F1_SXRectal

Does the patient report rectal symptoms (e.g., discharge, pain, itching, bleeding)?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response.




44

F1_SXPharyngeal

Does the patient report oral symptoms (e.g., soreness, pain, blisters)?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response..




45

F1_SXAbdomen

Did the patient report abdominal pain?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response.




46

F1_SXDysuria

Did the patient report dysuria?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response.




47

F1_SXDischarge

Did the patient report a vaginal (abnormal), rectal or penile discharge?"



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response.




48

F1_SXLesion

Does the patient report an oral or genital ulcer/blister?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response.




48.1

F1_Sxitching

Did the patient report a vaginal (abnormal), rectal or penile (urethral) itching?






1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response.




48.2

F1_SXPain

Did the patient report a vaginal (abnormal), rectal or genital pain?






1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response.




48.3

F1_SXRash

Did the patient report a genital/anal rash?






1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response.

48.4

F1_Sxbleeding

Did the patient report a vaginal (abnormal), rectal or (urethral ) penile bleeding?






1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response.




49

F1_PEDischarge

Is there a finding of abnormal discharge on physical exam?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response, or 3(patient is a female).




50

F1_PEAbdomen

Is there a finding of lower abdominal pain/tenderness on physical exam?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but (1) is unknown for this record or (2) there is not an opportunity for a “no” response, or 3(patient is a female).




53

F1_HIVTest

Does the patient report ever tested for HIV? (excluding HIV testing on today’s visit)?



1= Yes



2= No



3= Patient does not know/ not sure



9= Not captured



If information is collected by the facility but patient is not sure, then appropriate response is 3. A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values allowed if information is collected by the facility but unknown for this record.




54

F1_HIVTestdate

When was the patient's most recent test for HIV (month and year)? (excluding HIV testing on today’s visit)?



Null values are allowed if (1) response to F1_HIVTest is either 2, 3, 9 or (2) patient does not know/ or not sure of the date of most recent HIV test.




55

F1_HIVResultlast

What was the result of the patient's most recent test for HIV (excluding HIV testing on today’s visit)?



0 = Negative



1 = Positive/preliminary positive



2 = Indeterminant



3= Patient does not know/ not sure



9 = Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value are allowed if (1) response to F1_HIVTest is either 2, 3,9 or (2) patient does not know/ or not sure of the result of the most recent HIV test.




56

F1_HIVTest_refuse

Did the patient refuse an HIV test today?



1= Yes



2= No



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but is unknown for this record.




57

F1_HregMatch

Was eHARS registry match done for this patient?



1=Yes



2=No



This data element may be initially coded as ‘2’ if the grantee conducts a batch match with their HIV registry and the case is reported before that batch is processed. This information can be updated in the SSuN record in the next data transmission following the match. This data element should not be ‘null’ or contain missing values.




58

F1_HIVcare

Is the patient currently in HIV care?



1=Yes



2=No



3= Patient is not HIV positive



4= Unknown



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but is unknown for this record.




59

F1_HregMatchStat

Did this patient match a registry entry in eHARS?



1=Matching Record Found



2=No Matching Record



3=Match Not Performed



This data element may be initially coded as ‘3’ if the grantee conducts a batch match with their HIV registry and the case is reported before that batch is processed. This information can be updated in the SSuN record in the next data transmission following the match. This data element should not be ‘null’ or contain missing values.




60

F1_HregID

Unique record number from HIV registry (such as stateno from eHARS).



This data element should not be ‘null’ or contain missing values if a matching record is present in eHARS




61

F1_HDXMOYR

What is this patient's earliest indication of HIV positive result?



This information can be obtained from the eHARS person table (HIVPMOYR) if eHARS match found (F1_HregMatchStat = 1).




62

F1_EXPMOD

Exposure mode from HIV registry.



1=MSM Only



2=IDU Only



3=Heterosexual Contact Only



4=MSM & IDU



5=IDU & Heterosexual Contact



6=MSM & Heterosexual Contact



7=MSM, IDU & Heterosexual Contact



8=Perinatal Exposure



9=Other/Unknown



This data element should not be ‘null’ or contain missing values if a matching record is present in eHARS (F1_HregMatchStat = 1).




63

F1_HPVVaxadmin

Was the patient given HPV vaccination at this visit?



1= Yes



2= No, not indicated/refused



3= No, clinic does not administer/offer HPV vaccination



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but is unknown for this record.




63.1

F1_MPXadmin

Was the patient given MPX vaccination at this visit?



1= Yes



2= No, not indicated/refused



3= No, clinic does not administer/offer MPX vaccination



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null values are allowed if the information is collected by the facility but is unknown for this record.




63.2

F1_GCtx

Was patient prescribed antimicrobials for gonorrhea treatment?



1= Yes



2= No, not indicated/refused



9= Not captured




63.3

F1_CTtx

Was patient prescribed antimicrobials for chlamydia treatment?



1= Yes



2= No, not indicated/refused



9= Not captured














Data Element Name




Description/Response Coding


Diagnosis Dataset





64

F2_PatientID

Unique patient identification number assigned by site



Will be a secondary key for merging diagnosis and visit record data; should correspond to F1_PatientID. This patient ID should be supplied by the site and may be an person ID assigned at the clinic level. This data element MUST NOT be ‘null’ or contain missing values.




65

F2_Eventid

Unique visit identification



Will be a secondary key for merging diagnosis and visit record data; should correspond to F1_Eventid. This record ID should be supplied by the site and may be an event or visit ID assigned at the clinic level. This data element MUST NOT be ‘null’ or contain missing values except if a treatment record exists independant of a visit.




66

F2_Visdate

Date of clinic visit



Will be a secondary key for merging diagnosis and visit record data; should correspond to F1_Visdate. This data element MUST NOT be ‘null’ or contain missing values except if a treatment record exists independent of a visit.




67

F2_DXCODE

Diagnosis Code



SY01=Syphilis, primary



SY02=Syphilis, secondary



SY03=Syphilis, early latent



SY04=Syphilis, late latent/Unknown



SY05=Syphilis, neurosyphilis



SY06=Syphilis, unspecified/other



GC01=Gonorrhea



CT01=Chlamydia



GW01=Genital Warts



HI01=HIV/AIDS



BV01=Bacterial vaginosis (BV)



TR01=Trichomoniasis



GH01=Genital Herpes



NU01=Nongonococcal Urethritis (NGU)



MC01=Muco-purulent cervicitis (MPC)



MG01=Mycoplasma genitalium



PI01=Pelvic Inflammatory Disease (PID)



EP01=Epididymitis



CC01=Chancroid



LV01=Lymphogranuloma venereum (LGV)



GI01=Granuloma Inguinale



CD01=Candidiasis



SC01=Scabies



PD01=Pediculosis



MPX1=MPX(Suspected)



MPX2=MPX(Probable)



MPX3=MPX(Confirmed)



CS01=Contact to STD



PG01=Pregnancy



NE01=Normal exam/diagnosis



OT01=Other



Null values allowed if information is collected by the facility but unknown for this record.





Data Element Name

Description/Response Coding


Laboratory Dataset




68

F3_PatientID

Unique patient identification number assigned by site



Will be a secondary key for merging with laboratory and visit record data; should correspond to F1_PatientID. This patient ID should be supplied by the site and may be an person ID assigned at the clinic level. This data element MUST NOT be ‘null’ or contain missing values.




69

F3_Eventid

Unique visit identification



Will be a secondary key for merging laboratory and visit record data ; should correspond to F1_Eventid. This record ID should be supplied by the site and may be an event or visit ID assigned at the clinic level. This data element MUST NOT be ‘null’ or contain missing values except in the cases of HIV eHARS lab match records (in which case the variable F3_SpecColdate will not be equal to F3_visdate).




69.1

F3_Source

Did lab record originate from eHARS match?



Default to 0 for records NOT coming from the eHARS registry, 1 for lab data from eHARS




70

F3_Visdate

Date of clinic visit



Will be a secondary key for merging laboratory and visit record data; should correspond to F1_Visdate. This data element MUST NOT be ‘null’ or contain missing values except in the cases of HIV eHARS lab match records (in which case the variable F3_SpecColdate will not be equal to F3_visdate.




71

F3_SpecColdate

Date of specimen collection for this laboratory observation



Date the laboratory specimen was collected. Specimen collection date in many cases will be the same as F3_visdate; however it can be different in the case of HIV eHARS lab records since they may be collected independant of the clinic visit. This data element MUST NOT be ‘null’ or contain missing values.




72

F3_Condtested

What condition was the patient tested for?



1 = Syphilis



2 = Gonorrhea



3 = Chlamydia



4 = Chancroid



5 = Trichomoniasis



6 = HIV/AIDS



7 = Bacterial vaginosis



8 = Herpes



9= Mycoplasm genitalium



20 = Pregnancy



Although a null value is allowed, sites should make every attempt to make sure the value is not a null value. A record for a lab condition not included in the list above, should not be submitted.




73

F3_Anatsite

What anatomic site was tested?



1 = Urethral



2 = Vaginal/cervical



3 = Urine



4 = Rectal



5 = Pharynx



6 = Blood



8 = Other



9= Not captured



Although a null value is allowed, sites should make every attempt to make sure the value is not a null value.




74

F3_Test_Type

What type of test was used? (Will be expanded, recoded)



1=Culture



2=NAAT



3=Non-amplified nucleic acid test/DNA probe



4=Gram Stain



5=DFA



6=Rapid HIV



7=ELISA



8=Western blot (deprecated code, see 27, 28 below)



9=Pooled RNA



10=RPR



11=VDRL



12=FTA



13=TP-PA



14=MHA



15=Wet Mount/Clue Cell



16=PH



17=Other, not listed



18=Unknown



22=HIV-1 IA (EIA or Other)



23=HIV-1/2 IA (EIA or Other)



24=HIV-2 IA (EIA or Other)



25=HIV-1/2 Ag/Ab (4th generation)



26=HIV-1/2 Type-Differentiating Immunoassay (4th generation)



27=HIV-1 Western Blot



28=HIV-2 Western Blot



29=HIV-1 IFA



30=HIV-1 Culture



31=HIV-2 Culture



32=HIV-1 p24 Antigen



33=HIV-1 RNA/DNA NAAT (Qualitative)



34=HIV-2 RNA/DNA NAAT (Qualitative)



35=HIV-1 RNA/DNA NAAT (Quantitative viral load)



36=HIV-2 RNA/DNA NAAT (Quantitative viral load)



37=CD4 T-lymphocytes



38=CD4 Percent



39=HIV-1 Genotype (PR Nucleotide Sequence)



40=HIV-1 Genotype (RT Nucleotide Sequence)



41=HIV-1 Genotype (PR/RT Nucleotide Sequence)



42=HIV-1 Genotype (IN Nucleotide Sequence)



43=HIV-1 Genotype (PR/RT/IN Nucleotide Sequence)



44=STARHS (BED)



45=STARHS (Vironostika-LS)



46=STARHS ( BIO-RAD AVIDITY)



47=STARHS (Other)



48=STARHS (Unknown)



49=Rapid (Retired)



50=HIV-1/2 Ag/Ab-Distinguishing Immunoassay



51=HIV-1 Genotype (EN Nucleotide Sequence)



52=HIV-1 Genotype (FI Nucleotide Sequence)



53=HIV-1/2 Ag/Ab and Type-Differentiating Immunoassay



54=HIV-1/2 Ag/Ab and Type-Differentiating IA - HIV-1 p24 Antigen Analyte



55=HIV-1/2 Ag/Ab and Type-Differentiating IA - HIV-1 Antibody Analyte



56=HIV-1/2 Ag/Ab and Type-Differentiating IA - HIV-2 Antibody Analyte



57=HIV-1/2 Type-Differentiating Immunoassay (Supplemental)



58=HIV-1/2 Type-Differentiating IA (Suppl) - HIV-1 Antibody Analyte



59=HIV-1/2 Type-Differentiating IA (Suppl) - HIV-2 Antibody Analyte



60=HIV-1 Genotype (Unspecified)



61=WB/IFA-Legacy



62=RIPA-Legacy



63=Latex Ag-Legacy



64=Peptide-Legacy



65=Rapid-Legacy



66=Iga-Legacy



67=IVAP-Legacy



68=Other HIV Antibody-Other-Legacy



69=Other HIV Antibody-Unspecified-Legacy



70=Viral Load-Other-Legacy



71=Viral Load-Unspecified-Legacy



72=HIV Detection/Antigen/Viral Load-Other-Legacy



73=HIV Detection/Antigen/Viral Load-Unspecified-Legacy



74=Syphilis EIA test



75=T. Vaginalis Rapid Test



76=T. Vaginalis NAAT



80=Pregnancy



81=T. Vaginalis Culture



88= Other



99=Not captured



Although a null value is allowed, sites should make every attempt to make sure the value is not a null value.




75

F3_Qualres

What was the qualitative test result?



0 = Negative



1 = Positive



2 = Nonreactive



3 = Reactive



4 = Indeterminate/equivocal



5=Unknown/no result



6 = QNS/Contaminated/Unsaturated



8 = Other/pending



9=Not captured



10= Gram Stain Only: Gram-negative intracellular diplococci (GNID)



11=Gram Stain Only: ≥2 WBCs / high power field without GNID



12= Gram Stain Only: NGU with <2WBC and no GNID



13= Gram Stain Only: negative results



Although a null value is allowed, sites should make every attempt to make sure the value is not a null value.




76

F3_Quantres

Numeric - or Ratio (for RPR/VDRL, e.g. 1:2, 1:4, etc.)




77

F3_QuantUnits

Units for quantitative results:



1=Copies/mL



2=Log Copies/mL



3=Cells/Cubic mm



4=CD4%



5=Titer Ratio



6=Cycles/Time (rtPCR)




DE #

Data Element Name

Description/Response Coding


Treatment Dataset




78

F4_PatientID

Unique patient identification number assigned by site



Will be a secondary key for merging treatment and visit record data; should correspond to F1_PatientID. This patient ID should be supplied by the site and may be an person ID assigned at the clinic level. This data element MUST NOT be ‘null’ or contain missing values.




79

F4_Eventid

Unique visit identification



Will be a secondary key for merging treatment and visit record data; should correspond to F1_EventID. This record ID should be supplied by the site and may be an event or visit ID assigned at the clinic level. This data element MUST NOT be ‘null’ or contain missing values except in the case where treatment date (f4_TxDate) is different from F4_Visdate.




80

F4_Visdate

Date of clinic visit



Will be a secondary key for merging treatment and visit record data; should not be ‘null’ or contain missing values except in the case where treatment date (f4_TxDate) is different from F4_Visdate.




81

F4_TxDate

Treatment Date



Date the treatment was dispensed or prescribed. Treatment date in many cases will be the same as F4_visdate; however it can be different if treatment was provided independant of the clinic visit. This data element MUST NOT be ‘null’ or contain missing values.




82

F4_Medication

What medication was prescribed to the patient (brand name)?



1=Penicillin G (benzathine, aqueous procaine, or aqueous crystalline)



2=Probenacid



10= Amoxicillin (Amoxil, Polymox, Trimox, Wymox)



11= Ampicillin (Omnipen, Polycillin, Polycillin-N, Principen, Totacillin)



20= Azithromycin (Zithromax)



21= Erythromycin base



22= Clindamycin (Cleocin)



23= Gentamicin (Garamycin, G-Mycin, Jenamicin)



30= Cefixime (Suprax)



31= Ceftizoxime (Cefizox)



32= Cefotaxime (Claforan)



33= Cefoxitin (Mefoxin)



34= Cefpodoxime (Vantin)



35= Ceftibuten (Cedax)



36= Cefdinir (omnicef)



37= Ceftriaxone (Rocephin)



38= Cefuroxime (Ceftin, Kefurox, Zinacef, Zinnat)



40= Ciprofloxacin (Cipro, Cipro XR, Ciprobay, Ciproxin)



41= Levofloxacin (Cravit, Levaquin)



42= Moxifloxacin (Avelox, Vigamox)



43= Ofloxacin (Floxin, Oxaldin, Tarivid)



44= Gemifloxacin (Factive)



50= Doxycycline (Doryx, Vibramycin)



60= Metronidazole (Flagyl, Helidac, Metizol, Metric 21, Neo-Metric, Noritate, Novonidazol)



61= Tinidazole (Tindamax)



70= Tenofovir/emtricitabine (Truvada, Descovy)



71= Raltegravir (Isentress)



72= Dolutegravir (Tivicay)



73=Apretude (Cabotegravir)



74= Hepatitis B vaccine



75= Hepatitis A vaccine



76= Doxy PEP



88= Other



99=Unknown



Although a null value is allowed, sites should make every attempt to make sure the value is not a null value.




83

F4_Medication_Oth

If the patient received a medication other than what is listed above as



indicated by response option #88, please provide name of other medication (Free text description of other medication)




83.1

F4_TxMethod

New Variable to capture method of administrtaion


1=PO - oral dosing



2=IM - intramuscular



3=IV - intravenous/infusion



4=Other



5=Unknown



6=Intravaginal



7=Topical




84

F4_Dosage

What was the dosage of the medication prescribed?



1= 100 mg



2= 125mg



3= 150mg



4= 200mg



5= 240mg



6= 250mg



7= 300mg



8= 320mg



9= 400mg



10= 500mg



11= 600mg



12= 750mg



13= 800mg



14= 1g



15= 2g



16= 50 mg



17=2.4 Million Units



18=7.2 Million Units



88= Other


99= Not captured



A response of 99 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value allowed if dosage is unknown or missing.




85

F4_Number_doses

Total number of doses prescribed?



Null value allowed if (1) number of total doses is unknown or missing or (2) the information is not captured or collected by the facility or is not provided to SSuN. Sites can either collect number_doses or duration. It is NOT necessary to collect both variables. Refills should not be include in number of doses.




86

F4_Dose_Freq

What is the frequency of doses?



1=one single dose



2= twice day



3= three times a day



4= four times a day



8= other



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value allowed if frequency of doses is unknown or missing.




87

F4_Duration

What duration was the medication prescribed for?



1= 1 day



2= 3 days



3= 5 days



4= 7 days



5= 10 days



6= 14 days



8= Other



9= Not captured



A response of 9 indicates the information is not captured or collected by the facility or is not provided to SSuN. Null value allowed if duration of medication is unknown or missing.




DE #

Data Element Name

Description/Response Coding


Facility Reference Dataset





88

F5_Facility_ID

Unique facility identifier



This ID should be supplied by the site and is a unique facility identifier from underlying surveillance systems or may be generated specifically for SSuN. Regardless of source, this ID must be unique and allow for longitudinal tracking of the facility. This data element MUST NOT be ‘null’ or contain missing values.




89

F5_SiteID

Unique site code



BA=Baltimore (Cycle II, Cycle III, Cycle IV)



CB=Columbus Ohio (Cycle IV)



CA=California (Cycle II, Cycle III, Cycle IV)



FL=Florida (Cycle III & Cycle IV)



IN=Indiana (Cycle IV)



MC=Multnomah County (Cycle III &Cycle IV)



NY=New York City (Cycle II, Cycle III, Cycle IV)



PH=Philadelphia (Cycle II, Cycle III, Cycle IV)



SF=San Francisco (Cycle II, Cycle III, Cycle IV)



WA=Washington (Cycle II, Cycle III, Cycle IV)



UT=UTAH (Cycle IV)



LA=Louisana (Cycle II)



VA=Virginia (Cycle II)



AL=Alabama (Cycle II)



CO=Colorado (Cycle II)



CH=Chicago (Cycle II)



MA=Massachusetts (Cycle III)



MN=Minnesota (Cycle III)



This data element MUST NOT be ‘null’ or contain missing values.




90

F5_Facility_name

What is the name of the facility?



This data element MUST NOT be ‘null’ or contain missing values.




91

F5_Facility_type

What is the facility type?



1= STD clinic



88= Other




92

F5_FQHC

Is this facility a FQHC?



1= Yes



2= No







93

F5_Facility_Address

What is the physical street address of the facility?




94

F5_Facility_City

In what city is the facility located?



FIPS code, example: 3290 (City of SF)




95

F5_Facility_State

In what state is the facility located?



FIPS code




96

F5_Facility_Zip

Zip code for the facility (9-digit ZIP code of facility)




97

F5_Point_contact

Point of contact at facility




98

F5_EPT

Does the facility have written policies governing expediated partner therapy?



1= Yes



2= No



9= Facility does not provide/prescribe/test




99

F5_PrEP

Does the facility have written policies governing referral or management of PrEP?



1= Yes



2= No



3= facility does not refer to or manage PrEP




100

F5_PrEP_Rx

Does the facility prescribe PrEP?



1= Yes



2= No




101

F5_PEP_Rx

Does the facility prescribe PEP?



1= Yes



2= No




102

F5_PrEP_Manage

Does the facility actively manage patients on PrEP?



1= Yes



2= No




103

F5_HPV_vaccine

Does the facility have written policies governing HPV vaccination?



1= Yes



2= No



9= Facility does not provide/prescribe/test




104

F5_HIV_algorithm

Does the facility have written policies governing HIV testing?



1= Yes



2= No



3= Facility does not provide/prescribe/test




105

F5_Screening_CT

Does the facility have written policies governing chlamydia screening?



1= Yes



2= No



3= Facility does not provide/prescribe/test




106

F5_Screening_GC

Does the facility have written policies governing gonorrhea screening?



1= Yes



2= No



3= Facility does not provide/prescribe/test




107

F5_Billing

Does the facility bill for STD services?



1= Yes



2 = No



9= Not captured




108

F5_Medical_record

Type of medical record system?



1= paper-based



2= electronic



3=combination



9= not sure




109

F5_Insurance

Is the facility in an insurance network?



1=Yes



2=No




Clinic Patient Survey

110

FS1_FirstVis

First visit at clinic?






1=Yes



2=No




111

FS1_Welcome

Do you feel that this clinic provides a welcoming and respectful environment?






1=Yes



2=No



3=Not Sure






What are the reasons for your visit to this clinic today (choose all that apply)?



Code Below

112

FS1_Reas1

Health problem or symptoms






1=Yes



2=No




113

FS1_Reas2

No health problems or symptoms, but came to get STD screening/check-up






1=Yes



2=No




114

FS1_Reas3

Told to get checked by partner






1=Yes



2=No




115

FS1_Reas4

Referred by health department/disease intervention specialist (DIS)






1=Yes



2=No




116

FS1_Reas5

Follow-up visit






1=Yes



2=No




117

FS1_Reas6

Came to get STD test results






1=Yes



2=No




118

FS1_Reas7

Came to get HIV test






1=Yes



2=No




119

FS1_Reas8

Came to get medication that I can take every day to prevent getting HIV infection before I am exposed to the virus (PrEP)






1=Yes



2=No




120

FS1_Reas9

Came to get medication that I can take right away because I think I was exposed to HIV in the past few days (PEP)






1=Yes



2=No




121

FS1_Reas10

Came to get contraception






1=Yes



2=No




122

FS1_Reas11

Some other reason






1=Yes



2=No




123

FS1_Reas12_TXT

Specify ____________________




124

FS1_ReasThisClin

What is the main reason you chose this clinic for care (choose only one)?



1=Could walk in or get same day appointment



2=Cost



3=Privacy concern



4=Expert care



5=Embarrassed to go to usual doctor



6=Some other reason




125

FS1_ReasThisClin_TXT

Please specify other reason ______________________




126

FS1_WhereElse

Where would you have gone today if this STD clinic did not exist (choose only one)?






1=I would have waited to see how I felt and then decided what to do



2=Community health center



3=Public clinic/ health department clinic



4=Family planning clinic



5=Private doctor’s office



6=Urgent care clinic/walk in clinic



7=Hospital emergency room (ER)



8=Hospital outpatient department



9=School-based clinic



10=Some other place




127

FS1_WhereElse_TXT

Please specify other place ______________________




128

FS1_UsualPlace

Is there a place that you USUALLY go to when you are sick or need advice about your health?






1=Yes



2=No




129

FS1_MostOftenGo

If YES, what kind of place do you go to most often (choose only one)?






1=Community health center



2=Public clinic/health department clinic



3=Family planning clinic



4=Private doctor’s office



5=Urgent care clinic/walk in clinic



6=Hospital emergency room (ER)



7=Hospital outpatient department



8=School-based clinic



9=Some other place




130

FS1_MostOftenGo_TXT

Please specify ________________________




131

FS1_PrevCare

Is there a place you USUALLY go to when you need routine care or preventive care such as a physical exam or check-up?






1=Yes



2=No




132

FS1_PrevCareGo

If YES, what kind of place do you go to most often (choose only one)






1=Community health center



2=Public clinic/health department clinic



3=Family planning clinic



4=Private doctor’s office



5=Urgent care clinic/walk in clinic



6=Hospital emergency room (ER)



7=Hospital outpatient department



8=School-based clinic



9=Some other place




133

FS1_PrevCareGo_TXT

Please specify ________________________




134

FS1_Insurance

Do you have health insurance (choose only one)?






1=Yes, parents’ insurance plan



2=Yes, government (Medicaid, Medicare, etc.)



3=Yes, private insurance (through employer)



4=Yes, private insurance (purchased by yourself/healthcare.gov exchange)



5=No coverage of any type à GO TO QUESTION # 13



6=Don’t know à GO TO QUESTION # 13




135

FS1_UseIns

If YES, would you be willing to use your health insurance for today’s visit?






1=Yes



2=No






If No, why not (choose all that apply)?




136

FS1_NOTUseIns1

I do not want my insurance company to know






1=Yes



2=No




137

FS1_NOTUseIns2

Insurance company might send records home






1=Yes



2=No




138

FS1_NOTUseIns3

I do not want my parents/spouse/significant other to know






1=Yes



2=No







139

FS1_NOTUseIns4

Usual doctor might send records home

140

FS1_NOTUseIns5

I cannot afford to pay the co-pay or deductible

141

FS1_NOTUseIns6

My insurance will not cover this visit

142

FS1_NOTUseIns7

Some other reason

143

FS1_NOTUseIns_TXT

Please specify




144

FS1_BirthSex

What sex were you assigned at birth on your original birth certificate?






1=Male



2=Female



3=Refused



4=Don't know




145

FS1_GendID

How do you currently describe yourself?






1=Male



2=Female



3=Trans, Male to Female



4=Trans, Female to Male



5=TG Unknown or Unspecified



6=Gender Queer/Non-Binary



7=Other




146

FS1_Age

How old are you? Age in years______




147

FS1_HispEth

Do you consider yourseld Hispanic/Latino/a?






1=Yes, Hispanic



2=No, Not Hispanic



8=Unknown/Can't guess



9=Refused






What is your race (choose all that apply)?

148

FS1_RaceWhite

White






1=Yes



2=No




149

FS1_RaceBlack

Black






1=Yes



2=No




150

FS1_RaceAIAN

AI/AN






1=Yes



2=No




151

FS1_RaceAsian

ASIAN






1=Yes



2=No




152

FS1_RaceNHOPI

NH/OPI






1=Yes



2=No




153

FS1_RaceOther

Other race






1=Yes



2=No




154

FS1_RaceUnk

Unknown/Can't guess






1=Yes



2=No




155

FS1_RaceRef

Refused Race






1=Yes



2=No




156

FS1_SexOrient

Which of the following best represents how you think of yourself?






1=Heterosexual/Straight



2=Gay/Lesbian/Homosexual



3=Bisexual



4=Other



5=I don't know



9=Refused






What is your current employment status (choose all that apply)?




157

FS1_Employ1

Full-time employment






1=Yes



2=No




158

FS1_Employ2

Part-time employment






1=Yes



2=No




159

FS1_Employ3

Unemployed






1=Yes



2=No




160

FS1_Employ4

Disabled






1=Yes



2=No




161

FS1_Employ5

Student






1=Yes



2=No




162

FS1_Employ6

Other






1=Yes



2=No




163

FS1_Educate

What is your highest level of school you have completed or the highest degree you have received



1=Middle school



2=Some high school



3=High school diploma



4=GED or equivalent



5=Some college



6=College degree or higher




Strategy B - Case-based Enhanced Surveillance


Data Element Name

Description

164

P1_SiteID




This 2 character code primarily identifies sites funded under SSuN Cycle 2 & 3 and will include additional sites as required for Cycle 4. This data element MUST NOT be ‘null’ or contain missing values.



BA=Baltimore (Cycle II, Cycle III, Cycle IV)



CB=Columbus (Cycle IV)



CA=California (Cycle II, Cycle III, Cycle IV)



FL=Florida (Cycle III & Cycle IV)



IN=Indiana (Cycle IV)



MC=Multnomah County (Cycle III &Cycle IV)



NY=New York City (Cycle II, Cycle III, Cycle IV)



PH=Philadelphia (Cycle II, Cycle III, Cycle IV)



SF=San Francisco (Cycle II, Cycle III, Cycle IV)



WA= Washington (Cycle II, Cycle III, Cycle IV)



UT=UTAH (Cycle IV)



LA=Louisana (Cycle II)



VA=Virginia (Cycle II)



AL=Alabama (Cycle II)



CO=Colorado (Cycle II)



CH=Chicago (Cycle II)



MA=Massachusetts (Cycle III)



MN=Minnesota (Cycle III)




165

P1_EventID

Site generated unique event identifier



This record ID should be supplied by the site and may be an event or report identifier from underlying surveillance system. Regardless of source, this ID must be unique for each confirmed case report. This data element MUST NOT be ‘null’ or contain missing values.




166

P1_PatientID

Site generated ID allows for longitudinal tracking of unique persons



This ID should be supplied by the site and may be a unique patient identifier from underlying surveillance systems or may be generated specifically for SSuN from identifying information provided through case reporting. Regardless of source, this ID must be unique and allow for longitudinal tracking of persons reported with multiple episodes of disease. This data element MUST NOT be ‘null’ or contain missing values.




167

P1_RecRepDte

Earliest date this specific disease event/report received at health department?



This date should reflect the earliest information available to the health department regarding the case. This date should include laboratory records received if lab results were reported prior to receipt of a provider case report. This data element MUST NOT be ‘null’ or contain missing values. This should be coded as a ‘SAS’ numeric date.




168

P1_DxDte

What is the diagnosis date for the current episode of disease (may be date of provider visit, specimen collection date, laboratory report date or other suitable proxy)



This data element should not be ‘null’ or contain missing values. This should be coded as a ‘SAS’ numeric date.




169

P1_DxCode

Diagnosis



This data element should not be ‘null’ or contain missing values. For this cycle of SSuN, only values for gonorrhea and for syphilis (10280 and 10311, 10312, 10313 and 10320 are acceptable)






10273=Chancroid



10274=Chlamydia



10280=Gonorrhea



10311=Syphilis, primary



10312=Syphilis, secondary



10313=Syphilis, early non-primary non-secondary



10320=Syphilis, unknown duration or late




170

P1_RandSamp

Is this record/case selected in the random sample?



This data element MUST NOT be ‘null’ or contain missing values. (Note: both gonorrhea and syphilis records should be sampled)






0=Not in random sample



1=In random sample




171

P1_SampDte

Date record/case sampled by jurisdiction



For jurisdiction deploying a batch process for record sampling, this should be the actual date that the batch was sampled. For jurisdictions deploying real-time sampling of cases through their surveillance system, this date should match the report date (or date case status was confirmed if appropriate). This data element should not be ‘null’ or contain missing values. This should be coded as a ‘SAS’ numeric date.










174

P1_InitSx

If patient previously reported, what is the registry/source of earliest report for this PATIENT? (If the patient was not known to have been previously reported for any disease/condition, this data element may be coded as '.'/Null)






0=STD Registry



1=HIV Registry



2=Viral Hepatitis Registry



3=Other Disease Registry



4=Unknown




175

P1_HregMatch

Was eHARS registry match done for this patient?



This data element may be initially coded as ‘2’ if the grantee conducts a periodic batch match with their HIV registry and the case is reported before that batch is processed. This information can be updated in the SSuN record in the next data transmission following the match. This data element should not be ‘null’ or contain missing values.



1=Yes



2=No




176

P1_HregMatchStat

Did this patient match a registry entry in eHARS?



This data element may be initially coded as ‘3’ if the grantee conducts a periodic batch match with their HIV registry and the case is reported before that batch is processed. This information can be updated in the SSuN record in the next data transmission following the match. This data element should not be ‘null’ or contain missing values.






1=Matching Record Found



2=No Matching Record



3=Match Not Performed




177

P1_HregID

Unique record number from HIV registry (such as stateno from eHARS).



This data element should not be ‘null’ or contain missing values if a matching record is present in eHARS. Sites may decide to use a locally generated UNIQUE registry number rather than STATENO as long as this number can be used to obtain matching HIV laboratory data)




178

P1_HDXMOYR

What is this patient's earliest indication of HIV positive result?



This information can be obtained from the eHARS person table (HIVPMOYR). If eHARS match found. This should be coded as character data (“MM/YY”) with missing information as “../..” or “../YY”




179

P1_EXPMOD

Exposure (HIV transmission) mode from HIV registry.



This data element should not be ‘null’ or contain missing values if a matching record is present in eHARS.






1=MSM Only



2=IDU Only



3=Heterosexual Contact Only



4=MSM & IDU



5=IDU & Heterosexual Contact



6=MSM & Heterosexual Contact



7=MSM, IDU & Heterosexual Contact



8=Perinatal Exposure



9=Other/Unknown







182

P1_PrevDx

Most recent previous diagnosis (if applicable; could include hep, TB or HIV)



If this patient also has a record in other/ancillary disease registries as indicated above, indicate the diagnosis documented by that record. Should be ‘Null’ if no previous diagnosis is confirmed. Note that previous gonorrhea diagnoses are captured in DE#184, prioritize non-gonorrhea diagnoses for this data element (HIV, syphilis, CT, etc.)






10311=Syphilis, primary



10312=Syphilis, secondary



10313=Syphilis, early non-primary non-secondary



10320=Syphilis, unknown duration or late



10280=Gonorrhea



10274=Chlamydia



10100=Hepatitis B, acute



10105=Hepatitis B, chronic



20001=Hepatitis C



10562=HIV infection (non-AIDS)



10560=AIDS



10307=Nongonococcal Urethritis (NGU)



10308=Muco-purulent cervicitis (MPC)



10309=Pelvic Inflammatory Disease (PID)



10273=Chancroid



10306=Lymphogranuloma venereum (LGV)



10276=Granuloma Inguinale



20002=TB



20003=Other




183

P1_PrevDxDte

Date of most recent previous diagnosis documented above.



Should not be null if P1_PrevDx is not null.




184

P1_PrevGCDx

Has the patient been previously diagnosed and reported with GC?






1=Yes



2=No



3=Registry records not searched




185

P1_PrevGCDxDte

Date of most recent previous diagnosis of GC documented above.



Should not be null if P1_PrevGCDx = 1. This should be coded as a ‘SAS’ numeric date.




186

P1_ConcurCTDx

Was this patient diagnosed with CT at the same time as their current GC diagnoses?






1=Yes, tested and found to be CT positive



2=No, tested and found to be CT negative



3=No, patient not tested for CT/No CT information available




187

P1_CaseDup

Is this record/case a duplicate report, new report or was duplicate status not determined?



The grantee should document if an initial case report was subsequently found to be a duplicate of an existing case – the record should be retained in the SSuN dataset and coded as a duplicate (‘1’)? If the jurisdiction receives a report that they know to be a duplicate (same patient/eent in last 28 days) at the time of report, the record can be omitted from the SSuN datasets and not sampled for enhanced investigation. This data element should not be ‘null’ or contain missing values.






0=New Case



1=Duplicate Case (previously reported in last 28 days)



9=Unknown, site surveillance system does not capture




188

P1_FacilityID

Site generated facility ID. Each reporting provider/facility must have a unique ID.



This is a primary key for linking the provider type and other provider information to the case record. Historically, the majority of cases in any grantee’s jurisdictions will be reported from known providers, but for cases reported from entirely new or unknown providers, this field should be populated with that facility’s new number and be included in the next update of the provider reference file. This data element should not be ‘null’ or contain missing values.







191

P1_PtxSex

Current sex of the patient as indicated on initial health department report?



This data element should not be ‘null’ or contain missing values. For transgender individuals, please record the gender direction (e.g. 'male' for a female to male trensgendered patient, if transgender but sex unknown, code as 9: "Unknown")






1=Male



2=Female



9=Unknown




192

P1_PtxGendID

Gender Identity of the patient as indicated on initial health department report.



This data element should not be ‘null’ or contain missing values. If this information is not reported on case or lab report, code as 9: "Gender Identity not documented"



1=Male-to-Female Transgender



2=Female-to-Male Transgender



3=Transgender, not specified



4=CIS Gender (Male or Female, NOT transgendered)



9=Gender Identity not documented




193

P1_PtxRace_White

White Race



Information from case/lab reports to the health department only. Patient self-report from interviews should be captured in interview variables. If additional information from any source (other than patient report) is received, these data may be updated as required by underlying surveillance system.






1=Yes



2=No



3=Unknown



4=Refused




194

P1_PtxRace_Black

Black Race



Information from case/lab reports to the health department only. Patient self-report from interviews should be captured in interview variables. If additional information from any source (other than patient report) is received, these data may be updated as required by underlying surveillance system.






1=Yes



2=No



3=Unknown



4=Refused




195

P1_PtxRace_AIAN

American Indian/Alaska Native Race



Information from case/lab reports to the health department only. Patient self-report from interviews should be captured in interview variables. If additional information from any source (other than patient report) is received, these data may be updated as required by underlying surveillance system.






1=Yes



2=No



3=Unknown



4=Refused




196

P1_PtxRace_Asian

Asian Race



Information from case/lab reports to the health department only. Patient self-report from interviews should be captured in interview variables. If additional information from any source (other than patient report) is received, these data may be updated as required by underlying surveillance system.






1=Yes



2=No



3=Unknown



4=Refused




197

P1_PtxRace_NHOPI

Native Hawaiian/Other Pacific Islander Race



Information from case/lab reports to the health department only. Patient self-report from interviews should be captured in interview variables. If additional information from any source (other than patient report) is received, these data may be updated as required by underlying surveillance system.






1=Yes



2=No



3=Unknown



4=Refused




198

P1_PtxRace_Other

Other Race



Information from case/lab reports to the health department only. Patient self-report from interviews should be captured in interview variables. If additional information from any source (other than patient report) is received, these data may be updated as required by underlying surveillance system.






1=Yes



2=No



3=Unknown



4=Refused




199

P1_PtxRace_UNK

Is all information on race and Hispanic ethnicity missing from initial



If additional/supplemental information is received on race and ethnicity of patient but this information was missing from the initial report to the health department, please leave this data element coded as ‘1’ and capture the source of supplemental information below.






1=Yes



2=No




200

P1_PtxRaceSource

What is the source of the final race information of record as ascertained for this patient?



For grantees able to distinguish the source of information for race, please indicate as appropriate. For grantees NOT able to distinguish the source of race data at all, code as ‘6’. If race information is missing/unknown from all sources, code as ‘5’.






1=Patient Self-Report



2=Provider Case Report



3=Laboratory Report



4=Previous Registry Record



5=No Information Available from Any Source



6=Source not Identifiable




201

P1_PtxHisp

Patient Hispanic ethnicity



Information from case/lab reports to the health department only. Patient self-report from interviews should be captured in interview variables. If additional information from any source (other than patient report) is received, these data may be updated as required by underlying surveillance system.






1=Hispanic



2=Non-Hispanic



3=Unknown



4=Refused




202

P1_PtxHISPSource

What is the source of the final Hispanic ethnicity information



For grantees able to distinguish the source of information for Hispanic ethnicity, please indicate as appropriate. For grantees NOT able to distinguish the source of Hispanic ethnicity data at all, code as ‘6’. If information is missing/unknown from all sources, code as ‘5’.






1=Patient Self-Report



2=Provider Case Report



3=Laboratory Report



4=Previous Registry Record



5=No Information Available from Any Source



6=Source not Identifiable




203

P1_PtxAGE

Age of patient from initial reporting record/document .



If age information is missing/unknown from all sources, use null value.




204

P1_PtxAgeUnit

Age unit



If #32 is null, use null value for this data element (‘.’)






1=Years



2=Months




205

P1_PtxCountyres

County of patient residence



If information is missing/unknown, code to null value ( ‘.’)




206

P1_PtxCTract

Census Tract of patient residence



If information is missing/unknown, code to null value (‘.’)




207

P1_PtxAddrStat

Was patient street address present and complete in initial reporting documents?



This data element should not be ‘null’ or contain missing values.






1=Street Address Known



2=Street Address Missing



3=Street Address Incomplete




208

P1_GCAccuracy

What is the basis of census tract assignment (XY coordinates, street segment, centroid, etc.)



This data element should not be ‘null’ or contain missing values.






1=Close (based on direct street segment, parcel, or lon/lat match.)



2=Approximate (modification of address required to match to to street segment)



3=Very approximate (based only on zip or city centroid)



4=Not-geocodable (insufficient data to geocode, PO Box, General Delivery)



9=Missing (no address available)




209

P1_SiteUrine

Urine 'site' of infection



If information is missing/unknown, code as ‘3’






1=Yes



2=No



3=Unknown




210

P1_SiteVagCerv

Vaginal or cervical site of infection in women



If information is missing/unknown, code as ‘3’






1=Yes



2=No



3=Unknown




211

P1_SiteUreth

Urethral site of infection - only if this is specifically indicated.



If information is missing/unknown, code as ‘3’






1=Yes



2=No



3=Unknown




212

P1_SiteRect

Rectal site of infection



If information is missing/unknown, code as ‘3’






1=Yes



2=No



3=Unknown




213

P1_SitePhar

Pharyngeal site of infection



If information is missing/unknown, code as ‘3’






1=Yes



2=No



3=Unknown




214

P1_SiteEye

Ocular site of infection



If information is missing/unknown, code as ‘3’






1=Yes



2=No



3=Unknown




215

P1_SiteSera

Blood or sera infection



If information is missing/unknown, code as ‘3’






1=Yes



2=No



3=Unknown




216

P1_SiteJoint

Joint or synovial fluid infection



If information is missing/unknown, code as ‘3’



1=Yes



2=No



3=Unknown




217

P1_SiteOTH

Site of infection, not specified above



If information is missing/unknown, code as ‘3’






1=Yes



2=No



3=Unknown




218

P1_SiteUNK

All site of infection information missing for this case - use only if no other information is available.



If the answer to any one of 40-48 above is ‘1’ or ‘2’ then this data element should be coded ‘2’. If all data elements 40-48 are coded as ‘3’ then code this data element as ‘1’.






1=Yes



2=No





Data elements from provider investigations

219

P2_ProvID




This data element MUST NOT be ‘null’ or contain missing values for cases in the random sample. SHOULD NOT be null for all other cases (collaborators requested to include this information for all gonorrhea case records – this can be accomplished with a default coding of P2_ProvID= P1_FacilityID.




220

P2_ProvCO

County FIPS code for provider/facility physical location



This should be coded as the 3-digit FIPS code for the county.




221

P2_ProvZIP

Facility/provider physical location 5-digit ZIP




222

P2_ProvCHC

Is facility/provider a Community Health Center (CHC)?



Community Health Centers are not-for-profit primary care organizations governed by a community board and whose primary mission is to provide medical services to traditionally under-served populations. The primary way of determining CHC status is by self-identification (though some put it in their name). The National Association of Community Health Centers (NACHC) does maintain member lists as well. Non-profit and community board governance are the key features.






1=Yes



2=No



3=Unknown




223

P2_ProvFQHC

Is facility/provider a Federally Qualified Health Center (FQHC)?



Federally qualified health centers (FQHCs) include all organizations receiving grants under Section 330 of the Public Health Service Act (PHS). These are a matter of public record and lists are available from HRSA






1=Yes



2=No



3=Unknown




224

P2_ProvPTXvisitDte

Date of patient initial visit for this issue, can be supplied/filled in from initial case report.



This should be formatted as a ‘SAS’ numeric date.




225

P2_ProvClinType

What was the category of provider examining/treating this patient?






1=MD



2=RN



3=PA



4=ARNP



5=LPN



6=Other



7=Unknown/Not Ascertained




226

P2_ProvPTX_GenderSP

Provider documented gender of sex partners






1=Males only



2=Females only



3=Both Males and Females



4=No Sex Partners Last 3 Mos



9=Not Captured/Not Documented




227

P2_ProvPTX_Insure

Insurance status of patient from provider's records






1=Yes, Insured



2=No, Not Insured



3=Unknown




228

P2_Urethritis

Was urethritis found on exam



Missing/unknown information code as null (‘.’).






1=Yes



2=No




229

P2_Proctitis

Was proctitis found on exam



Missing/unknown information code as null (‘.’).






1=Yes



2=No




230

P2_Epididymitis

Was epididymitis found on exam



Missing/unknown information code as null (‘.’).






1=Yes



2=No




231

P2_PID

Was PID diagnosed.



Missing/unknown information code as null (‘.’).






1=Yes



2=No




232

P2_Discharge

Was discharge found on exam



Missing/unknown information code as null (‘.’).






1=Yes



2=No




233

P2_OtherFinding

Were there other STD-related findings on exam



Missing/unknown information code as null (‘.’).






1=Yes



2=No




234

P2_NoFinding

Were there NO findings on exam



Missing/unknown information code as null (‘.’).






1=Yes



2=No




235

P2_ProvScrnUreth

Was patient screened/tested for infection at urethral site






1=Yes



2=No



3=Unknown



4=Refused




236

P2_ProvScrnVagCerv

Was patient screened/tested for infection at vaginal/cervical site






1=Yes



2=No



3=Unknown



4=Refused




237

P2_ProvScrnAnal

Was patient screened/tested for infection at anorectal site






1=Yes



2=No



3=Unknown



4=Refused




238

P2_ProvScrnPhar

Was patient screened/tested for infection at pharyngeal site






1=Yes



2=No



3=Unknown



4=Refused




239

P2_ProvScrnHIV

Was patient screened/tested for HIV infection at time of visit






1=Yes



2=No



3=Unknown



4=Refused





Treatment Repeating Table (sourced either from initial case report or provider investigations)




240

P2_PR_EventID

Primary key for merging treatment records with case file, should be the same as P1_EventID






Must not be missing or null.




241

P2_PR_ProvPTX_TxDte

Treatment date (or date of administration, date prescription given)



This should be coded as a ‘SAS’ numeric date. Missing/unknown information code as null (‘.’).




242

P2_PR_DrugName

What drug was patient treated with?






01=Penicillin G (benzathine, aqueous procaine, or aqueous crystalline)



02=Probenacid



10= Amoxicillin (Amoxil, Polymox, Trimox, Wymox)



11= Ampicillin (Omnipen, Polycillin, Polycillin-N, Principen, Totacillin)



20= Azithromycin (Zithromax)



21= Erythromycin base



22= Clindamycin (Cleocin)



23= Gentamicin (Garamycin, G-Mycin, Jenamicin)



30= Cefixime (Suprax)



31= Ceftizoxime (Cefizox)



32= Cefotaxime (Claforan)



33= Cefoxitin (Mefoxin)



34= Cefpodoxime (Vantin)



35= Ceftibuten (Cedax)



36= Cefdinir (omnicef)



37= Ceftriaxone (Rocephin)



38= Cefuroxime (Ceftin, Kefurox, Zinacef, Zinnat)



40= Ciprofloxacin (Cipro, Cipro XR, Ciprobay, Ciproxin)



41= Levofloxacin (Cravit, Levaquin)



42= Moxifloxacin (Avelox, Vigamox)



43= Ofloxacin (Floxin, Oxaldin, Tarivid)



44= Gemifloxacin (Factive)



50= Doxycycline (Doryx, Vibramycin)



60= Metronidazole (Flagyl, Helidac, Metizol, Metric 21, Neo-Metric, Noritate, Novonidazol)



61= Tinidazole (Tindamax)



70= Truvada (Tenofovir/emtricitabine)



71=Raltegravir (Isentress)



72=Dolutegravir (Tivicay)



88= Other (provide text in P2_PR_OthMedTXT)



99=Not Captured



Must not be missing or null.




243

P2_PR_OthMedTXT

Other medication if value of 88 selected for P2_PR_DrugName




244

P2_PR_Dosage

Dosage - numeric



Missing/unknown information code as null (‘.’).




245

P2_PR_Dose_Units

Dosage units






01-Miligrams (mg)



02-Grams (g)



03-Units



04-Units/Kilogram



05-Million Units



06-Million Units/Kilogram



07-Milliliters (ml)




246

P2_PR_Method

Method of administration






01=PO - oral dosing



02=IM - intramuscular



03=IV - intravenous/infusion



04=Other



05=Unknown



Missing/unknown information code as null (‘.’).




247

P2_PR_Number

Number of doses/day






0=Single dose, STAT



Numeric value for all other



Missing/unknown information code as null (‘.’).




248

P2_PR_Duration_Number

Days duration or frequency of doses



Missing/unknown information code as null (‘.’).





Data elements from provider investigations

249

P2_ProvPTX_PDPT




Missing/unknown information code as null (‘.’).






1=Yes



2=No




250

P2_ProvPTX_HIBC

Was patient counseled to prevent transmission/reinfection?



Missing/unknown information code as null (‘.’).






1=Yes



2=No




250.1

P2_ProvPTX_PrepRx

Was patient prescribed PrEP?






1=Yes



2=No



Missing/unknown information code as null (‘.’).




250.2

P2_ProvPTX_dPEPRx

Was patient prescribed doxycycline as STI prophylaxis?






1=Yes



2=No



Missing/unknown information code as null (‘.’).




251

P2_ProvPTX_Refer

Was patient referred to HD (or other) for partner services?



Missing/unknown information code as null (‘.’).






1=Yes



2=No




252

P2_ProvPTX_PrepRefer

Was patient referred for PrEP?



Missing/unknown information code as null (‘.’).






1=Yes



2=No





Data elements from Patient Interviews




253

P3_IDX_ID

Interviewer/Investigator ID



This is a locally assigned ID to uniquely identify the person conducting patient interview. This data element should not be ‘null’ or contain missing values for interviewed cases.




254

P3_PatientID

Unique identifier for person/patient



Will be a secondary key for merging data; should correspond to P1_PatientID. This data element should not be ‘null’ or contain missing values for interviewed cases.




255

P3_EventID

Unique identifier for record



Will be a primary key for merging data; should correspond to P1_EventID. This data element should not be ‘null’ or contain missing values for interviewed cases.




256

P3_IDX_CADate1

Contact attempt date 1



This data element should not be ‘null’ or contain missing values for interviewed cases.




257

P3_IDX_CAout1

Contact attempt outcome 1



This data element should not be ‘null’ or contain missing values for interviewed cases.






0=Answer/Partial or Complete Interview Obtained



1=No Answer/No Message



2=No Answer/Message Left



3=Answer/Hang up



4=Answer/Refusal



5=Answer/Reschedule DIS call-back



6=Answer/Reschedule Patient Callback



7=Number out of service



8=Other




258

P3_IDX_CADate2

Contact attempt date 2



This should be coded as a ‘SAS’ numeric date.




259

P3_IDX_CAout2

Contact attempt outcome 2






0=Answer/Partial or Complete Interview Obtained



1=No Answer/No Message



2=No Answer/Message Left



3=Answer/Hang up



4=Answer/Refusal



5=Answer/Reschedule DIS call-back



6=Answer/Reschedule Patient Callback



7=Number out of service



8=Other




260

P3_IDX_CADate3

Contact attempt date 3



This should be coded as a ‘SAS’ numeric date.




261

P3_IDX_CAout3

Contact attempt outcome 3






0=Answer/Partial or Complete Interview Obtained



1=No Answer/No Message



2=No Answer/Message Left



3=Answer/Hang up



4=Answer/Refusal



5=Answer/Reschedule DIS call-back



6=Answer/Reschedule Patient Callback



7=Number out of service



8=Other




262

P3_IDX_CADate4

Contact attempt date 4



This should be coded as a ‘SAS’ numeric date.




263

P3_IDX_CAout4

Contact attempt outcome 4






0=Answer/Partial or Complete Interview Obtained



1=No Answer/No Message



2=No Answer/Message Left



3=Answer/Hang up



4=Answer/Refusal



5=Answer/Reschedule DIS call-back



6=Answer/Reschedule Patient Callback



7=Number out of service



8=Other




264

P3_IDX_Ixdate

Interview/Disposition Date



This should be coded as a ‘SAS’ numeric date.




265

P3_IDX_Dispo

Patient Investigation/Interview Disposition



Should not be ‘null’ for cases included in random sample.






00=Investigation complete: patient contacted, interview completed



01=Investigation complete: patient contacted, partial interview completed



10=Investigation not complete: Phase 3 investigation pending



11=Investigation not complete: patient contacted, refused interview



12=Investigation not complete: patient contacted, unable to complete because of language barrier



22=Investigation not complete: patient did not respond to contact attempts



33=Investigation not complete: patient contact not initiated because patient resident in correctional, mental health or substance abuse facility



44=Investigation not complete: patient contact not initiated because patient is active military on foreign deployment



55=Investigation not complete: >60 days from diagnosis



66=Investigation not complete: case determined to be OOJ



77=Investigation not complete: insufficient contact information



88=Investigation not complete: provider refused patient contact



99=Investigation not complete: administrative closure/other reason




266

P3_PTX_age

What is your age?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






888=Refused




267

P3_PTX_Birthsex

What was your sex at birth (recorded on your birth certificate)?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.



1= Male



2=Female



3=Intersex



4=Unknown



9=Refused




267.1

P3_PTX_GendID

What gender or sex do you consider yourself to be?






1=Male



2=Female



3=Male-to-Female TG



4=Female-to-Male TG



5=TG Unspecified



6=Queer, Gender Non-binary



7=Other



8=Refused




268

P3_PTX_HispEthnic

Do you consider yourself to be Hispanic or Latino/a?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Unknown



4=Refused







271

P3_PTX_White

patient reported White race



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Unknown



4=Refused




272

P3_PTX_Black

patient reported Black race



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Unknown



4=Refused




273

P3_PTX_AIAN

patient reported AIAN race



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Unknown



4=Refused




274

P3_PTX_AIAN_TXT

Tribal Affiliation




275

P3_PTX_Asian

patient reported Asian race



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Unknown



4=Refused







277

P3_PTX_NHOPI

patient reported NHOPI race



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Unknown



4=Refused




279

P3_PTX_OTHrace

patient reported other race



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Unknown



4=Refused




280

P3_PTX_OTHraceTxt

Patient-reported other race







281

P3_PTX_RefRace

patient refuses provision of all race information



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No







285

P3_PTX_Insure

Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare, Indian Health Services, the V.A. or Military?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




286

P3_PTX_InsType

What kind of healthcare insurance do you have?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Private healthcare insurance provided by my employer



2=Private healthcare insurance I pay for myself



3=Public healthcare insurance like Medicaid, Medicare, or a "state-specific health plan"



4=Active or retired military or dependent plan like the V.A. or



5=Bureau of Indian Affairs/IHS/Urban Indian Health



7=Other



8=Don‘t know / Not sure



9=Refused




287

P3_PTX_OthInsSpecify

Other type of insurance (text)




288

P3_PTX_PriCareDoc

Do you have one person you think of as your personal doctor or health care provider?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes, only one



2=More than one or facility



3=No



4=Don't Know /Not Sure



5=Refused




289

P3_PTX_Hccost

Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




290

P3_PTX_OOPE

When you went to see _______________ (mention provider, clinic or facility name) when you were diagnosed with gonorrhea, did you need to pay anything out-of-pocket at the time of your visit?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




291

P3_PTX_SYMP1

Before you went to see _______________ (mention provider, clinic or facility name) when you were diagnosed with gonorrhea, did you have any unusual discharge or oozing from your (penis/vagina)?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




292

P3_PTX_SYMP2

Before you went to see _______________ (mention provider, clinic or facility name) did you notice any unexplained sores or bumps on your (penis/vagina)?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




293

P3_PTX_SYMP3

Before you went to see _______________ (mention provider, clinic or facility name) when you were diagnosed with gonorrhea, did you have any pain or burning when you urinated?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




294

P3_PTX_SYMP4

Did you go to the doctor that time because you were having symptoms or pains you thought might be from an STD



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused







295

P3_PTX_Delay

How long did you have these symptoms or pains before you were able to see the doctor?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=1 Day



2=2 - 6 Days



3=1 - 2 weeks



4=More than 2 weeks



5=Don‘t know / Not sure / Don’t remember



6=Refused




296

P3_PTX_ExpSTD

Before you went to the doctor that time, did any of your sex partners tell you that you might have been exposed to an STD?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused







309

P3_PTX_PartnerTest

Did the doctor, nurse or anyone else during that visit talk to you about the importance of getting your sex partners examined and tested for STDs?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




310

P3_PTX_TellParts

In the time since your visit, did you tell any of your sex partners they may need to tested or treated for STDs?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




311

P3_PTX_EPToffer

Did a doctor, nurse or someone at the health department offer to give you medications or a prescription for you to give to any of your sex partner(s)?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




312

P3_PTX_EPTWHO

Who was it that offered you the additional medications or prescriptions? Was it someone from your doctor’s office or someone from the health department?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=My doctor’s office



2=The health department



3=Someone else



4=Don‘t know / Not sure



5=Refused




313

P3_PTX_EPTGET

Did you actually get the additional medications or prescriptions for your sex partners?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




314

P3_PTX_EPTMEDORRX

Did you get medicine to give to your partner? Or did you get prescriptions that your partners needed to have filled at a pharmacy?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=I got additional medications



2=I got prescription(s)



3=Don‘t know / Not sure




315

P3_PTX_EPTGAVE

Did you give the additional medications or prescriptions to at least one of your sex partners?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



9=Refused




316

P3_PTX_EPTPARTTAKE

Do you think at least one of your sex partners took this medication?






1=Yes, I think at least one of my partner(s) took this medicine



2=No, I do not think any of my partner(s) took these medicines



9=Refused







317

P3_PTX_HIVtested

Did you get tested for HIV at that visit?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ (P3_IDX_Dispo) = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




318

P3_PTX_HIVresult

What was the result of your HIV test at that visit?



This data element should not be ‘null’ or contain missing values if P3_PTX_HIVtested=1.






1=Positive



2=Negative



3=Don't Know / Not Sure / did not get results



4=Refused




319

P3_PTX_everHIVtst

Have you ever been tested for HIV?



May be ‘Null’ if P3_PTX_HIVtested=1. This data element should not be ‘null’ or contain missing values for cases responding with 2, 3 or 4 to P3_PTX_HIVtested.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




320

P3_PTX_whenHIVtest

When was your last HIV test? Just month and year is ok? (IF PATIENT UNABLE TO RECALL, PROBE UNTIL APPROXIMATE RESPONSE ELICITED)



This should be character data ”MM/YYYY”, missing/REFUSED information as”../YYYY” or “../….”




321

P3_PTX_HIVeverResult

What was the result of that HIV test?



This data element should not be ‘null’ or contain missing values for cases responding to P3_PTX_everHIVtst=1.






1=Positive



2=Negative



3=Don't Know / Not Sure / did not get results



4=Refused




322

P3_PTX_inHIVcare

When was your most recent visit to a doctor, nurse or other health



This data element should not be ‘null’ or contain missing values for cases identifying as HIV positive (P3_PTX_HIVResult=1 or P3_PTX_HIVeverResult=1). This should be entered as character data ”MM/YYYY”, missing/REFUSED information as”../YYYY” or “../….”




323

P3_PTX_ART

Are you taking antiretroviral medicines to treat your HIV infection?



This data element should not be ‘null’ or contain missing values for cases identifying as HIV positive (P3_PTX_HIVResult=1 or P3_PTX_HIVeverResult=1). This should be entered as character data ”MM/YYYY”, missing/REFUSED information as”../YYYY” or “../….”






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




324

P3_PTX_PrEP

When you were diagnosed with gonorrhea, did your health care provider or anyone else discuss medications to help you prevent getting HIV?



This data element should be ‘null’ for patients reporting being HIV positive. This data element should not be ‘null’ or contain missing values for patients identifying as HIV negative or unknown HIV status.



0=No, I am already on PrEP



1=Yes



2=No



3= Don‘t know / Not sure



4=Refused




325

P3_PTX_PREP1

Did your health care provider offer to prescribe or give you



medications to help you prevent getting HIV?



This data element should not be ‘null’ or contain missing values if patient reports PrEP.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




326

P3_PTX_PREP2

Did you fill a prescription or get medications to help you prevent getting HIV?






This data element should not be ‘null’ or contain missing values for those answering “Yes” to P3_PTX_PrEP.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




327

P3_PTX_PREP3

Are you currently taking daily medications to help you prevent



getting HIV (on PrEP)? This is often called PrEP, or pre-exposure prophylaxis.



This data element should not be ‘null’ or contain missing values.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused

327.1

P3_mpox

Has a doctor or other health care provider ever told you that you had Mpox (monkeypox)?


1=Yes

2=No

3= Don't Know/Not sure/Unknown

4=Refused


327.2

P3_mpox_vax

Have you ever received a vaccine for mpox?






1=Yes



2=No (skip to 328)



3=Don't Know/Not sure/Unknown (skip to 328)



4=Refused (skip to 328)




327.3

P3_mpox_vaxD

How many doses of vaccine for mpox have you received?






1=One



2=Two



3=Don't Know/Not sure/Unknown



4=Refused




327.4

P3_mpox_vaxDTE

When was your last mpox vaccine shot?






This should be character data: ”MM/YYYY”,



missing/REFUSED information as”../YYYY” or “../….”




328

P3_PTX_Pregnant

Were you pregnant at the time you were told that you had gonorrhea?



This data element should not be ‘null’ or contain missing value for female cases interviewed. May be null for partial interviews, must be null for male cases.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




329

P3_PTX_GenderSP

During the past 12 months, have you had sex with only males, only females or both?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo) = ‘1’, partial interview.






1=Males only



2=Females only



3=Both Males and Females



4=Unknown



9=refused




330

P3_PTX_TGSP

During the past 12 months, have you had sex with a transgender man or transgender woman?






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




331

P3_PTX_Sxorient

Do you consider yourself to be…



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo) = ‘1’, partial interview.






1=Heterosexual/Straight (not Gay or Lesbian)



2=Gay/Lesbian/Homosexual



3=Bisexual



4=Other/Don't Know



9=Refused




332

P3_PTX_MaleSPL3MO

Thinking back to the 3 months before you were diagnosed with



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo = ‘1’, partial interview. Probe for approximate response or ‘best’ guess. Enter 0 to indicate ‘None’, 9999 to indicate “Refused”.




333

P3_PTX_FemaleSPL3MO

Thinking back to the 3 months before you were diagnosed with



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo = ‘1’, partial interview. May be ‘Null’ if P3_IDX_Dispo = ‘1’, partial interview. Probe for approximate response or ‘best’ guess. Enter 0 to indicate ‘None’, 9999 to indicate “Refused”.




334

P3_PTX_SPtreatOne

To the best of your knowledge, was your sex partner treated?



This data element is for patient reporting only a single sex partner.






1=Yes, definitely



2=Yes, probably



3=Don't Know / Not Sure



4=No, probably not



5=Refused



6=No need/no partners infected




335

P3_PTX_SPtreatMult

To the best of your knowledge, would you say that all of your sex partners were definitely treated, at least one of your partners was definitely treated, or that none were treated?



This data element is for patients reporting multiple sex partners.






1=All definitely treated



2=At least one definitely treated



3=At least one probably treated



4=Not sure



5=Probably none treated



6=Refused



7=No need/no partners infected




336

P3_PTX_SexExch

During the past 12 months, have you given drugs or money in exchange for sex or received drugs or money in exchange for sex? By sex we mean vaginal, oral, or anal sex.



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Don't Remember/ Not Sure



4=Refused




337

P3_PTX_Opioid

In the past year, how often have you used prescription pain medications



other than as prescribed by a doctor?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if #107 (P3_IDX_Dispo) = ‘1’, partial interview.






1=Never



2=Once or Twice



3=Monthly



4=Weekly



5=Daily or Almost Daily



9=Refused




338

P3_IVDU

In the past year, have you used any injection drugs such as heroin, cocaine or meth?






1=Yes



2=No



3=Don’t Know/Can’t Remember



4=Refused




339

P3_IVDU_HER

In the past year, did you inject heroin?






1=Yes



2=No



3=Don’t Know/Can’t Remember



4=Refused




339.1

P3_IVDU_COC

In the past year, did you inject cocaine/crack?






1=Yes



2=No



3=Don’t Know/Can’t Remember



4=Refused




339.2

P3_IVDU_MTH

In the past year, did you inject Crystal Meth/Methamphetamine/Methadrone?






1=Yes



2=No



3=Don’t Know/Can’t Remember



4=Refused




339.3

P3_IVDU_OXY

In the past year, did you inject Oxycodone/morphine/Fentanyl/Carfentanil/some other opioid?






1=Yes



2=No



3=Don’t Know/Can’t Remember



4=Refused




339.4

P3_IVDU_OTH

In the past year, did you inject other durgs not listed?






1=Yes



2=No



3=Don’t Know/Can’t Remember



4=Refused




340

P3_IVDU_DR_TX

Other drug injected text.







341

P3_PTX_LastSex

When was the last time you had sex?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo = ‘1’, partial interview.






1=In last week



2=> 1 week but within last month



3=> 1 month, but within 2 months



4=> 2 months ago



5=Don't Know / Not sure



9=Refused




342

P3_PTX_GenderMRSP

Thinking back to the last time you had sex, was the person you had sex with…?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo = ‘1’, partial interview.






1=Male (not transgender)



2=Female (not transgender)



3=Male-to-Female TG



4=Female-to-Male TG



5=TG But Unknown or Unspecified



6=Queer, Gender Non-binary



7=Other



9=Refused or Not Captured




343

P3_PTX_AgeMRSP

Thinking back to the last person you had sex with, how old do you think that person is? If you don’t know for sure, it’s OK to make your best guess.



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo = ‘1’, partial interview.




344

P3_PTX_HISPMRSP

Would you say that person is Hispanic/Latino/a? If you don’t know for sure, it’s OK to make your best guess.



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo = ‘1’, partial interview.






1=Yes, Hispanic



2=No, Not Hispanic



8=Unknown/Can't guess



9=Refused




345

P3_PTX_RaceMRSP

Thinking back to the last person you had sex with, what race(s) would you say that person is? If you don’t know for sure, it’s OK to make your best guess.



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo = ‘1’, partial interview.






1=White



2=Black



3=AI/AN



4=ASIAN



5=NH/OPI



6=Multiple Races



7=Unknown/Can't guess



9=Refused




346

P3_PTX_MRSPHIV

Thinking back to the last person you had sex with, do you know if that person HIV positive?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo = ‘1’, partial interview.






1=Yes, I know that person is HIV positive



2=No, I know that person is HIV negative



3=Don't Know /Don't Remember/ Not Sure



4=Refused




347

P3_PTX_SexAgainMRSP

Thinking back to the last person you had sex with; do you think you will have sex with this person again?



This data element should not be ‘null’ or contain missing values for interviewed cases. May be ‘Null’ if P3_IDX_Dispo = ‘1’, partial interview.






1=Yes



2=No



3=Don't Know /Maybe/ Not Sure



4=Refused











Data Element Name

Description/Response Coding


Laboratory Observation Dataset - sourced from laboratory reporting or case investigations




351

P1_L1_EventID

Unique identifier for associated surveillance record



Will be a primary key for merging lab and case data; should correspond to P1_EventID. This data element MUST NOT be ‘null’ or contain missing values.




352

P1_L1_LabID

Unique identifier for laboratory performing testing



Site assigned; may be ID from other system or specifically created for SSuN. If performing lab is not known, site should still create a lab record with a locally defined ID corresponding to unknown lab that they will use throughout the SSuN data collection period. This data element should not be ‘null’ or contain missing values.




353

P1_L1_Accession

Unique identifier (accession number) for laboratory record



Leave blank (null) if not available/ascertained




353.1

P1_L1_Source

Did this lab record originate from eHARS Match?



Default code to '0' for lab record NOT from eHARS




354

P1_L1_PatientID

Unique identifier for person (allowing longitudinal tracking of persons)



Will be a secondary key for merging lab and case data; should correspond to P1_PatientID. This data element MUST NOT be ‘null’ or contain missing values.




355

P1_L1_CondTested

specific condition/pathogen tested



This data element MUST NOT be ‘null’ or contain missing values.






1=Syphilis



2=Gonorrhea



3=Chlamydia



4=Genital Herpes



5=Trichomoniasis



6=HIV



7=Hep A



8=Hep B



9=Hep C



10=BV



11=Other




356

P1_L1_SpecColDte

Specimen collection date - this is often used as a proxy for diagnosis



This data element should not be ‘null’ or contain missing values. This should be coded as a ‘SAS’ numeric date.




357

P1_L1_LabRepDte

This is the date that the performing lab reported the results to the



This should be coded as a ‘SAS’ numeric date.




358

P1_L1_SpecType

Type of specimen



This data element should not be ‘null’ or contain missing values.






1=Exudate



2=Blood/sera



3=Synovial fluid



4=Urine



5=CSF



6=Tissue



7=Saliva



8=Other



9=Unknown




359

P1_L1_AnatSite

This is the anatomic site from which the specimen was obtained and is important in determining the anatomic site of infection.



This data element should not be ‘null’ or contain missing values.






1=Urethra



2=Vagina/cervix



3=Urine



4=Rectum



5=Pharynx



6=Eye



7=Sera/Blood



8=Joint



9=Other Anatomic Site



10=Unknown Anatomic Site




360

P1_L1_TestType

As test technology advances, it is important to obtain the type of test performed



This data element should not be ‘null’ or contain missing values.






1=Culture



2=NAAT



3=Non-amplified nucleic acid test/DNA probe



4=Gram Stain



5=DFA



6=Rapid HIV



7=ELISA



8=Western blot (deprecated code, see 27, 28 below)



9=Pooled RNA



10=RPR



11=VDRL



12=FTA



13=TP-PA



14=MHA



15=Wet Mount/Clue Cell



16=PH



17=Other, not listed



18=Unknown



22=HIV-1 IA (EIA or Other)



23=HIV-1/2 IA (EIA or Other)



24=HIV-2 IA (EIA or Other)



25=HIV-1/2 Ag/Ab



26=HIV-1/2 Type-Differentiating Immunoassay



27=HIV-1 Western Blot



28=HIV-2 Western Blot



29=HIV-1 IFA



30=HIV-1 Culture



31=HIV-2 Culture



32=HIV-1 p24 Antigen



33=HIV-1 RNA/DNA NAAT (Qualitative)



34=HIV-2 RNA/DNA NAAT (Qualitative)



35=HIV-1 RNA/DNA NAAT (Quantitative viral load)



36=HIV-2 RNA/DNA NAAT (Quantitative viral load)



37=CD4 T-lymphocytes



38=CD4 Percent



39=HIV-1 Genotype (PR Nucleotide Sequence)



40=HIV-1 Genotype (RT Nucleotide Sequence)



41=HIV-1 Genotype (PR/RT Nucleotide Sequence)



42=HIV-1 Genotype (IN Nucleotide Sequence)



43=HIV-1 Genotype (PR/RT/IN Nucleotide Sequence)



44=STARHS (BED)



45=STARHS (Vironostika-LS)



46=STARHS ( BIO-RAD AVIDITY)



47=STARHS (Other)



48=STARHS (Unknown)



49=Rapid (Retired)



50=HIV-1/2 Ag/Ab-Distinguishing Immunoassay



51=HIV-1 Genotype (EN Nucleotide Sequence)



52=HIV-1 Genotype (FI Nucleotide Sequence)



53=HIV-1/2 Ag/Ab and Type-Differentiating Immunoassay



54=HIV-1/2 Ag/Ab and Type-Differentiating IA - HIV-1 p24 Antigen Analyte



55=HIV-1/2 Ag/Ab and Type-Differentiating IA - HIV-1 Antibody Analyte



56=HIV-1/2 Ag/Ab and Type-Differentiating IA - HIV-2 Antibody Analyte



57=HIV-1/2 Type-Differentiating Immunoassay (Supplemental)



58=HIV-1/2 Type-Differentiating IA (Suppl) - HIV-1 Antibody Analyte



59=HIV-1/2 Type-Differentiating IA (Suppl) - HIV-2 Antibody Analyte



60=HIV-1 Genotype (Unspecified)



61=WB/IFA-Legacy



62=RIPA-Legacy



63=Latex Ag-Legacy



64=Peptide-Legacy



65=Rapid-Legacy



66=Iga-Legacy



67=IVAP-Legacy



68=Other HIV Antibody-Other-Legacy



69=Other HIV Antibody-Unspecified-Legacy



70=Viral Load-Other-Legacy



71=Viral Load-Unspecified-Legacy



72=HIV Detection/Antigen/Viral Load-Other-Legacy



73=HIV Detection/Antigen/Viral Load-Unspecified-Legacy



80=Pregnancy



88= Other



99=Not captured




361

P1_L1_QualRes

Qualitative result: For most pathogens/tests, positive, negative,



This data element should not be ‘null’ or contain missing values.






1=Positive



2=Negative



3=Reactive



4=Weakly Reactive



5=Non-Reactive



6=Equivocal/Indeterminate



7=Specimen Inadequate/Contaminated



8=Other



9=Unknown




362

P1_L1_Quantres

Numeric - or Ratio (for RPR/VDRL, e.g. 1:2, 1:4, etc.)




363

P1_L1_QuantUnits

Units for quantitative results:



1=Copies/mL



2=Log Copies/mL



3=Cells/Cubic mm



4=CD4%



5=Titer Ratio



6=Cycles/Time (rtPCR)





Data Element Name

Description/Response Coding


Provider Reference Dataset (information should be updated annually)




364

P4_ProvID

Unique identifier for provider/facility



This data element MUST NOT be ‘null’ or contain missing values.




365

P4_ProvName

Name of provider or facility




366

P4_ProvCO

FIPS code for provider/facility physical location




367

P4_ProvZIP

Facility/provider physical location 5-digit ZIP



This data element should not be ‘null’ or contain missing values.




368

P4_UpdateDate

Date provider information last updated/verified



This data element should not be ‘null’ or contain missing values. This




369

P4_LocationLon

Provider physical location longitude




370

P4_LocationLat

Provider physical location latitude




371

P4_CensusTract

Census tract of provider physical location




372

P4_Prov_Fac_Type

Facility or provider type code (PHINVAD compatible)



This data element MUST NOT be ‘null’ or contain missing values.






1=Blood Bank



Includes for-profit sera collection centers



2=Correctional Facilities



Includes jails, prisons, juvenile detention, etc.



3=Day care center (environment)



4=Dentist



5=Drug Treatment Facility



6=Emergency Room/Emergency Department



Include HMO/other urgent care in this category



7=Family Planning Facility



Includes reproductive health clinics



8=Other Federal Agencies



Do not include bureau of prisons in this category (should be 2,



9=HIV Care Facility



Includes and care facility whose primary service is HIV care



10=HIV Counseling and Testing Site



Include HIV outreach & street testing in this category



11=Hospital - Not ED/ER



This should include in-patient facilities where the patient was



12=Labor and Delivery



13=Laboratory



14=Managed Care/HMOs



15=Mental Health Provider



16=Military



17=National Job Training Program



18=Other, not otherwise specified



19=Other Health Department Clinic



Do not include health department clinics whose primary



20=Other State and Local Agencies



21=Other Treatment Center



22=Pharmacy



23=Prenatal/Obstetrics Facility



24=Private physicians' group office



25=Public Health Clinic



Include ONLY public clinics not otherwise categorized



26=Data/Disease Registries



27=Rural Health Clinic



Includes clinics specifically designated as RHCs on the Centers



28=Categorical STD Clinic



29=School-Based Clinic



30=TB Clinic



31=Tribal Government Clinic



Do not include IHS hospitals (those are coded as 32)



32=Indian Health Service



33=Veterinary Sources



34=Vital Statistics



99=unknown




373

P4_ProvCHC

Is facility/provider a Community Health Center (CHC)?



This data element should not be ‘null’ or contain missing values.






1=Yes



2=No



3=Unknown/Missing




374

P4_ProvFQHC

Is facility/provider a Federally Qualified Health Center (FQHC)?



This data element should not be ‘null’ or contain missing values.






1=Yes



2=No



3=Unknown/Missing




375

P5_S1SiteID

Site ID



This 2 character code primarily identifies sites funded under SSuN Cycle 2 & 3 and will include additional sites as required for Cycle 4. This data element MUST NOT be ‘null’ or contain missing values.



BA=Baltimore (Cycle II, Cycle III, Cycle IV)



CB=Columbus (Cycle IV)



CA=California (Cycle II, Cycle III, Cycle IV)



FL=Florida (Cycle III & Cycle IV)



IN=Indiana (Cycle IV)



MC=Multnomah County (Cycle III &Cycle IV)



NY=New York City (Cycle II, Cycle III, Cycle IV)



PH=Philadelphia (Cycle II, Cycle III, Cycle IV)



SF=San Francisco (Cycle II, Cycle III, Cycle IV)



WA= Washington (Cycle II, Cycle III, Cycle IV)



UT=UTAH (Cycle IV)



LA=Louisana (Cycle II)



VA=Virginia (Cycle II)



AL=Alabama (Cycle II)



CO=Colorado (Cycle II)



CH=Chicago (Cycle II)



MA=Massachusetts (Cycle III)



MN=Minnesota (Cycle III)




376

P5_S1EventID

Site generated unique event identifier



This record ID should be supplied by the site and may be an event or report identifier from underlying surveillance system. Regardless of source, this ID must be unique for each confirmed case report. This data element MUST NOT be ‘null’ or contain missing values. This must match the syphilis record in the Strategy B case file.




377

P5_S1PatientID

Site generated ID allows for longitudinal tracking of unique persons



This ID should be supplied by the site and may be a unique patient identifier from underlying surveillance systems or may be generated specifically for SSuN from identifying information provided through case reporting. Regardless of source, this ID must be unique and allow for longitudinal tracking of persons reported with multiple episodes of disease. This data element MUST NOT be ‘null’ or contain missing values. This must match the syphilis record in the Strategy B case file.




378

P5_S1PREG_NETSS

Pregnancy status for female syphilis cases



1=Yes



2=No



9=Unknown




379

P5_S1HIVSTAT_NETSS

Documented or self-reported HIV status at the time of event.



P = HIV positive



N = HIV negative



E = Equivocal HIV test



U = Unknown



R = Refused to answer



D = Did not ask




380

P5_S1MSex12_NETSS

Had sex with a male within past 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




381

P5_S1FSex12_NETSS

Had sex with a female within past 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




382

P5_S1AnSex12_NETSS

Had sex with an anonymous partner within past 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




383

P5_S1SxIDU12_NETSS

Had sex with an IVDU within past 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask

384

P5_S1SxINTX12_NETSS

Had sex wwhile intoxicated within past 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




385

P5_S1SxEX12_NETSS

Exchanged drugs/money for sex within past 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




386

P5_S1SxFMSM12_NETSS

Had sex with MSM in last 12 months (females only)?






Y=Yes



N=No



R=Refused



D=Did not ask




387

P5_S1IVDU12_NETSS

Engaged in injection drug use in last 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




388

P5_S1Crack12_NETSS

Used crack last 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




389

P5_S1Coke12_NETSS

Used cocaine last 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




390

P5_S1Heroin12_NETSS

Used heroin last 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




391

P5_S1Meth12_NETSS

Used methamphetamine last 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




932

P5_S1Pops12_NETSS

Used poppers/nitrates last 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




393

P5_S1EDdru12_NETSS

Used ED drugs last 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




394

P5_S1OTHdru12_NETSS

Used other drugs last 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




395

P5_S1NOdru12_NETSS

No drug use reported last 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




396

P5_S1INCAR12_NETSS

Incarcerated in last 12 months?






Y=Yes



N=No



R=Refused



D=Did not ask




397

P5_S1STIever_NETSS

Does the patient have a history of ever having had an STD prior to the condition reported in this case report?






Y=Yes



N=No



U=Unknown



R=Refused




398

P5_S1SxInet12_NETSS

Did the patient use an online computer site to exchange messages by typing them onscreen to engage in conversation with other visitors to the site for the purpose of having sex?






Y=Yes



N=No



R=Refused



D=Did not ask




399

P5_S1TotSP12_NETSS

Total number of sex partners last 12 months (###)






888=Refused



999=Unknown




400

P5_S1LSNANUS_NETSS

One or more lesion(s) indicative of syphilis were present in the anus or rectum.






Y=Yes



U=Default




401

P5_S1LSNPENIS_NETSS

One or more lesion(s) indicative of syphilis were present on the penis.






Y=Yes



U=Default




402

P5_S1LSNSCRO_NETSS

One or more lesion(s) indicative of syphilis were present on the scrotum.






Y=Yes



U=Default




403

P5_S1LSNVAGI_NETSS

One or more lesion(s) indicative of syphilis were present on the vagina.






Y=Yes



U=Default




404

P5_S1LSNCERV_NETSS

One or more lesion(s) indicative of syphilis were present on the cervix.






Y=Yes



U=Default




405

P5_S1LSNPHAR_NETSS

One or more lesion(s) indicative of syphilis were present in the nasopharynx.






Y=Yes



U=Default




406

P5_S1LSNORAL_NETSS

One or more lesion(s) indicative of syphilis were present in the mouth/oral cavity.






Y=Yes



U=Default




407

P5_S1LSNEYE_NETSS

One or more lesion(s) indicative of syphilis were present in the eye/conjunctiva.






Y=Yes



U=Default




408

P5_S1LSNHEAD_NETSS

One or more lesion(s) indicative of syphilis were present on the head.






Y=Yes



U=Default




409

P5_S1LSNTORS_NETSS

One or more lesion(s) indicative of syphilis were present on the torso.






Y=Yes



U=Default




410

P5_S1NEURO_NETSS

Does the patient have neurologic manifestations of syphilils?



. = Missing



1=Yes, Verified



2=Yes, Likely



3=Yes, Possible



4=No



9=Unknown




411

P5_S1OCULAR_NETSS

Does the patient have ocular manifestations of syphilils?



. = Missing



1=Yes, Verified



2=Yes, Likely



3=Yes, Possible



4=No



9=Unknown




412

P5_S1OTIC_NETSS

Does the patient have otic manifestations of syphilils?



. = Missing



1=Yes, Verified



2=Yes, Likely



3=Yes, Possible



4=No



9=Unknown




413

P5_S1LATE_NETSS

Does the patient have late clinical manifestations of syphilils?



. = Missing



1=Yes, Verified



2=Yes, Likely



4=No



9=Unknown










Form Approved


OMB No. 0920-1072


Expiration Date: XX/XX/XXXX




Attachment 5 – Data Elements List OMB Control#0920-1072 58


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorStenger, Mark R. (CDC/DDID/NCHHSTP/DSTDP)
File Modified0000-00-00
File Created2023-08-02

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