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Medications/prophylaxis prescriptions

Wesleyan University Davison Health Center Travel Consultation
Name: ___________________________________ Age: ______ Phone: ________ Box# ______ Medical History (including splenectomy, Diabetes, Sickle Cel Disease, immune deficiency, immune modulating drugs): ____________________________________________________________________ Current medications: __________________________________________________________________ Medication allergies (including vaccines, anti-malarials):_________________________________________ Wil you use/require contraception while abroad? Yes ___ No ___ Do you wish to take emergency contraception (Plan B) with you? _______ If your health insurance includes prescription coverage, please check with your insurer before your Health Center appointment to see whether or not your prescription plan includes travel vaccines (e.g., Rabies pre- exposure, Yel ow Fever) and malaria prophylaxis. Need for vaccines and malaria prophylaxis depends on your travel itinerary. Knowing in advance what kind of prescription coverage you have wil expedite your travel consult. Note: Wesleyan University’s insurance does not cover any vaccines or prescription medication.
Itinerary (list countries and dates in anticipated order of travel)
City, Country: _____________________________________ Dates: ___________________________
Type of travel/study (Please circle any that apply to you): Classroom-based study Details, including ful name of program:______________________________________________ Type of accommodation (Please circle any that apply to you): Apartment Details: _____________________________________________________________________________
Previous travel to developing areas: _______________________________________________________
Do you need a pre-travel physical exam and/or forms completed? Yes ____ No ____
(You wil need a separate appointment for this.) Travel Vaccine History
Meningitis vaccine (Type?) Yel ow Fever
Vaccine Prices below subject to change – ask at front office
Immunizations
Required
Required
Recommended
Recommended
Hepatitis A ($55/dose; 2 doses, lifetime) Japanese Encephalitis (3 doses, 2 years) Hepatitis B ($55/dose; 3 doses, lifetime?) Inactive Polio Vaccine (IPV) ($35; lifetime) Typhoid Oral Live vaccine (Vivotif)*
Medication
Directions
1 tablet weekly beginning 1-2 weeks before travel, continuing during travel, and for 4 weeks after leaving a malarious area. Take with food and 8 oz. As for Chloroquine, but begin 2-3 weeks before travel (assess tolerance, side effects). 1 tablet daily beginning 1-2 days before travel, continuing during travel, and for 4 weeks after leaving a malarious area. Take after meal with a full glass of water. Use sunscreen with UVA/UVB 1 tablet daily beginning 1-2 days before travel, continuing during travel, and for one week after leaving a malarious area. Take with food or milky Diarrhea
Medication
Directions
Packets of oral rehydration solution are available in the pharmacies of most countries and can be mixed with clean drinking water. A similar solution can be made by adding 1/2 teaspoon of salt, 1/2 teaspoon of baking soda, and 4 tablespoons of sugar to one 2 tablets initial y, then 1 tab after each unformed 1 tablet twice a day for 3 days for severe diarrhea 1 tablet daily for 3 days for severe diarrhea High Altitude
Medication
Directions
1 tablet every 12 hours for 3 days, beginning day before ascent, on the day of ascent, and on the Do not use if Sulfa allergy! Q12h If insomnia, may continue to take dose at bedtime Jet Lag / Motion sickness /Other
Medication
Directions
Discussed
Vaccine indications, side effects and contraindications Importance of compliance with chemoprophylaxis. Traveler’s diarrhea prevention and treatment (safe food and water) Other insect-borne disease prevention and treatment Sexually transmitted infection prevention (Including obtaining supplies of regular or occasional medications) Travel insurance/ Medical evacuation coverage Post travel follow-up services including TB test 8-12 weeks after return. Resources
Supplied
CDC Health Information for International Travel URL ___________________________________________

Source: http://www.wesleyan.edu/healthservices/office/Travel%20Consult%205-06.pdf

theijst.com

The International Journal Of Science & Technoledge (ISSN 2321 – 919X) THE INTERNATIONAL JOURNAL OF SCIENCE & TECHNOLEDGE Synthesis and Biological Evaluation of Some New Pyrazoline Derivatives of Vanillin Analogue V. R. Dangar Department of Chemistry, Kamani Science College, Amreli, Gujarat, India J. V. Dodia Department of Chemistry, Kamani Sc ience College,

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SAFETY DATA SHEET _____________________________________________________________________________ 1. IDENTIFICATION OF THE SUBSTANCE/PREPARATION AND OF THE COMPANY/UNDERTAKING Product Name: Gallic Acid Monohydrate Catalog Number: 73801 SDS Number: M00253 Chemical Name: 3,4,5-Trihydroxybenzoic Acid Monohydrate Chemical Formula: C7H6O5 · H2O Chemical Family:

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