| 46098-0 | Sex | |
| 30525-0 | Age | required |
| 46501-3 | Date assessment information completed:Date:RptPeriod:^Patient:Qn:CMS Assessment | |
| 78746-5 | Country of birth | |
| 66475-5 | Primary country before 10 PhenX | |
| 66476-3 | Country of citizenship | |
| 66477-1 | Country of current residence | |
| 66478-9 | Immigrant PhenX | |
| 66479-7 | Date arrived USA PhenX | |
| 66396-3 | Trip number PhenX | |
| 66397-1 | Country number | |
| 66398-9 | Trip start PhenX | |
| 66399-7 | Trip end PhenX | |
| 66400-3 | Travelled this Y PhenX | |
| 66401-1 | Travelled last Y PhenX | |
| 66402-9 | Travelled 2Ys ago PhenX | |
| 66403-7 | Travelled 3Ys ago PhenX | |
| 66404-5 | Travelled 4Ys ago PhenX | |
| 66405-2 | Travelled 5Ys ago PhenX | |
| 66406-0 | Stay 30Ds this Y PhenX | |
| 66407-8 | Stay 30Ds last Y PhenX | |
| 66408-6 | Stay 30Ds 2Ys ago PhenX | |
| 66409-4 | Stay 30Ds 3Ys ago PhenX | |
| 66410-2 | Stay 30Ds 4Ys ago PhenX | |
| 66411-0 | Stay 30Ds 5Ys ago PhenX | |
| 66412-8 | Other country exposure PhenX | |
| 66413-6 | Country exposure sequence PhenX | |
| 66414-4 | Specific place exposure PhenX | |
| 66415-1 | Reason for travel PhenX | |
| 66416-9 | Risk level qualifier PhenX | |
| 66417-7 | Clinical setting PhenX | |
| 66418-5 | Patient type PhenX | |
| 66419-3 | Pre-travel health provider PhenX | |
| 66420-1 | Abnormal lab test PhenX | |
| 66421-9 | Asymptomatic screening | |
| 66422-7 | Main presenting symptom PhenX | |
| 66427-6 | Presenting symptom other PhenX | |
| 66428-4 | Working Dx number PhenX | |
| 66429-2 | Working Dx status PhenX | |
| 66430-0 | Disease not travel related PhenX | |