LSMP Travel Risk Assessment

LSMP Travel Risk Assessment
Gender
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Are you currently pregnant?
Are you currently breast feeding?
Are you planning a pregnancy near travel?
Holiday type
Accommodation
Travelling
Staying in area which is
Planned activities
Have you ever had a serious reaction to a vaccine given to you before?
Have you taken out travel insurance and if you have a medical condition, informed the insurance company about this?
Have you ever had any of the following vaccinations / malaria tablets?
Please also add the dates you had these
Declaration