Clinical Specialties and Disease Epidemiology

1. Clinical Specialties and Disease Epidemiology

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* 1. Facility Name:

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* 2. Please select all specialties available in your facility (i.e. “in house” as opposed to referral elsewhere).

Allergy & Immunology

Breast Surgery

Cardiology

Cardiothorac Surgery

Dermatology

Emergency Medicine

Endocrinology

Gastroenterology

General Internal Medicine

General Surgery

Geriatric Medicine

Gynecology (non-obstetrical)

Hematology

Infectious Diseases

Mastology

Maxillofacial Surgery

Neonatology

Nephrology

Neurological Surgery

Neurology

Obstetrics

Oncology, Medical

Oncology, Surgery

Ophthalmology

Orthopedic Surgery

Otorhinolaryngology

Pathology

Pediatrics

Physical Medicine and Rehabilitation

Plastic Surgery

Podiatric Medicine

Psychiatry

Pulmonology

Radiation Therapy

Radiology

Rheumatology

Urology

Vascular Surgery

Other (please specify)

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* 3. Which of the following procedures are available at your facility? Please select all that apply.

Cesarean section delivery of pregnancy

Image-guided biopsy

Surgical biopsy

Fluid/abscess drainage

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* 4. How frequently do you treat patients with the following medical conditions? Please provide any helpful comments (for example, if you see a lot of cancer patients, you may want to comment on the most common malignancies you treat). Also, if you commonly treat a medical condition not listed below, please include it in the "others" section.

	Infrequently	Sometimes	Frequently
Cardiac disease	Cardiac disease Infrequently	Cardiac disease Sometimes	Cardiac disease Frequently
Chagas Disease	Chagas Disease Infrequently	Chagas Disease Sometimes	Chagas Disease Frequently
Stroke	Stroke Infrequently	Stroke Sometimes	Stroke Frequently
Dengue	Dengue Infrequently	Dengue Sometimes	Dengue Frequently
Diabetes	Diabetes Infrequently	Diabetes Sometimes	Diabetes Frequently
Cancer	Cancer Infrequently	Cancer Sometimes	Cancer Frequently
Trauma and Musculoskeletal Injury	Trauma and Musculoskeletal Injury Infrequently	Trauma and Musculoskeletal Injury Sometimes	Trauma and Musculoskeletal Injury Frequently
Pregnancy	Pregnancy Infrequently	Pregnancy Sometimes	Pregnancy Frequently
Peripartum hemorrhage	Peripartum hemorrhage Infrequently	Peripartum hemorrhage Sometimes	Peripartum hemorrhage Frequently
Diarrheal Illness	Diarrheal Illness Infrequently	Diarrheal Illness Sometimes	Diarrheal Illness Frequently
HIV/AIDS	HIV/AIDS Infrequently	HIV/AIDS Sometimes	HIV/AIDS Frequently
Tuberculosis	Tuberculosis Infrequently	Tuberculosis Sometimes	Tuberculosis Frequently
Viral Hepatitis	Viral Hepatitis Infrequently	Viral Hepatitis Sometimes	Viral Hepatitis Frequently
Malaria	Malaria Infrequently	Malaria Sometimes	Malaria Frequently
Schistosomiasis	Schistosomiasis Infrequently	Schistosomiasis Sometimes	Schistosomiasis Frequently
Filariasis	Filariasis Infrequently	Filariasis Sometimes	Filariasis Frequently
Trypanosomiasis	Trypanosomiasis Infrequently	Trypanosomiasis Sometimes	Trypanosomiasis Frequently
Leishmaniasis	Leishmaniasis Infrequently	Leishmaniasis Sometimes	Leishmaniasis Frequently
Echinococcus	Echinococcus Infrequently	Echinococcus Sometimes	Echinococcus Frequently

Others

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* 5. Additional comments?

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