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Travel Medicine Questionnaire Mobile App

The Travel Medicine Questionnaire mobile app is designed to assist when patients need to travel. The app includes patient information, itinerary, purpose of travel, type of travel, accommodations and destinations. A GoCanvas account can be specified as being HIPAA compliant. By turning on HIPAA compliance, a number of features that most of users find desirable will be disabled to meet HIPAA Standards. Individual apps in the GoCanvas Application Store can easily be made HIPAA Compliant. If you have any questions or need assistance you can contact our Sales team to help you at Sales@GoCanvas.com. If you would like to enable HIPAA on your GoCanvas account please follow the instructions below: 1. Log onto your Account 2. Click “My Account” in the top right corner of the screen 3. Click “Customize” on the left 4. The third option is for HIPAA Compliance, click “Edit” on the right 5. Check the “Enable HIPAA Compliance” box and select “Save”

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Travel Medicine Questionnaire Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Patient Name:

  • Ico date

    DOB:

  • Ico textbox

    Legal Name of Traveler:

  • Ico dropdown

    Gender:

  • Ico date

    DOB:

  • Ico textbox

    Birthplace:

  • Ico multiline

    Home Address:

  • Ico textbox

    Home Phone:

  • Ico textbox

    Business Phone:

  • Ico textbox

    Primary Care Physician:

  • Ico textbox

    Phone:

  • Ico textbox

    Emergency Notification:

  • Ico textbox

    Phone:

  • Ico textbox

    Relationship:

  • Ico date

    Departure Date:

  • Ico date

    Return Date:

  • Ico time

    Length of Trip:

  • Ico checkbox

    Business

  • Ico checkbox

    Vacation

  • Ico checkbox

    Field Worked

  • Ico checkbox

    Diving

  • Ico checkbox

    Relocation

  • Ico checkbox

    Safari

  • Ico checkbox

    Teaching/Study

  • Ico checkbox

    Climbing

  • Ico checkbox

    Missionary Work

  • Ico checkbox

    Other

  • Ico checkbox

    Group/Tour

  • ...and More!

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