NIH Disaster Research Response

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Academic Network for Sexual and Reproductive Health and Rights Policy [Ghent University] (ANSER) (2)
Achenbach System of Empirically Based Assessment (ASEBA) (2)
Action Against Hunger (ACF) (1)
Agency for Toxic Substances and Disease Registry (ATSDR) (3)
American Academy of Orthotists and Prosthetists (1)
American Academy of Pediatrics (AAP) (1)
American College of Rheumatology (1)
American Medical Association (AMA) (1)
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American Thoracic Society (ATS) (1)
American Tinnitus Association (1)
Arizona State University (ASU) (1)
Association for Contextual Behavioral Science (ACBS) (2)
Australian Mental Health Outcomes and Classification Network (AMHOCN) (1)
Boston Children's Hospital (1)
Boston College (1)
Boston University (BU) (1)
Brandeis University (1)
Brigham and Women’s Hospital (BWH) (1)
COVID-19 Prevention Network Statistical and Data Management Center (CoVPN) (1)
California Health Care Foundation (CHCF) (1)
Carnegie Mellon University (1)
Cengage (1)
Center for Economic and Social Research [University of Southern California Dornsife] (CESR) (1)
Center for Health Security [Johns Hopkins University, Bloomberg School of Public Health] (1)
Center for Pediatric Traumatic Stress [Children's Hospital of Philadelphia, Nemours A.I. duPont Hospital for Children] (1)
Centers for Disease Control and Prevention (CDC) (18)
Centers for Disease Control and Prevention, Center for Preparedness and Response (CDC CPR) (1)
Centers for Disease Control and Prevention, National Center for Environmental Health (CDC NCEH) (6)
Centers for Disease Control and Prevention, National Center for Health Statistics (CDC NCHS) (4)
Centers for Disease Control and Prevention, Office of Infectious Diseases (CDC OID) (1)
Centers for Medicare & Medicaid Services (CMS) (1)
Children and War Foundation (5)
Children's Hospital of Eastern Ontario (1)
Children’s Hospital of Michigan (1)
Christopher Newport University (CNU) (2)
City of New York, Department of Health and Mental Hygiene (NYC DOHMH) (3)
Columbia University (6)
Columbia University, Mailman School of Public Health (1)
Compassion Fatigue Awareness Project (1)
Connor-Davidson Resilience Scale (1)
Cornell University (2)
Disaster Research Response Program [National Institutes of Health] (DR2) (7)
Disaster and Community Crisis Center [University of Missouri] (DCC) (1)
Duke University (8)
EuroQol (1)
European Monitoring Centre for Drugs and Drug Addiction (1)
European Union, European Commission (2)
FACIT Measurement System (1)
Family Behavior Systems (1)
Family Practice Notebook (1)
Federal Emergency Management Agency [Department of Homeland Security] (FEMA) (1)
Fordham University (2)
Fort Refuge (1)
Freie Universitat Berlin (1)
GL Assessment (1)
Georgetown University (1)
Global Consortium for Chemosensory Research (GCCR) (1)
Government of Western Australia (1)
Green’s Publishing (1)
HIV Vaccine Trial Network Statistical and Data Management Center (HVTN) (1)
Harvard College (1)
Harvard Program in Refugee Trauma (HPRT) (2)
Harvard University (1)
Harvard University, Harvard Medical School (HMS) (1)
Harvard University, Harvard T.H. Chan School of Public Health (5)
Heartland Forgiveness Project (1)
Icahn School of Medicine at Mount Sinai (ISMMS) (1)
Imperial College London (1)
Institute for Work and Health (IWH) (1)
International Academies of Emergency Dispatch (IAED) (1)
International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) (4)
International Union Against Tuberculosis and Lung Disease (1)
Iowa State University (1)
Johns Hopkins Center for Public Health Preparedness [Johns Hopkins University] (1)
Johns Hopkins School of Medicine (1)
Johns Hopkins University (1)
Johns Hopkins University, Bloomberg School of Public Health (3)
Kaiser Family Foundation (KFF) (3)
Kandilli Observatory And Earthquake Research Institute [Bogazici University] (1)
Kennedy Krieger Institute (1)
Kent State University (1)
King's College of London (1)
Kyoto University (1)
Langer Research Associates (1)
Levenson Institute for Training (1)
Louisiana State University (LSU) (1)
Loyola University Chicago, Stritch School of Medicine (SSOM) (1)
Mapi Research Trust (4)
Medical Research Council (MRC) (1)
Michigan State University (MSU) (2)
Monell Chemical Senses Center (1)
Mongan Institute [Massachusetts General Hospital] (2)
Montreal Behavioural Medicine Centre (MBMC) (1)
Mount Sinai Hospital [Canada] (1)
Multi-Ethnic Study of Atherosclerosis (MESA) [National Heart Lung and Blood Institute] (1)
Multi-Health Systems, Inc. (MHS) (6)
NORC at the University of Chicago (NORC) (3)
National Alzheimer’s Coordinating Center (NACC) (2)
National Association of County and City Health Officials (NACCHO) (1)
National Center for PTSD [Post-Traumatic Stress Disorder] [U.S. Department of Veterans Affairs] (14)
National Child Traumatic Stress Network (NCTSN) (3)
National Environmental Education Foundation (NEEF) (1)
National Heart, Lung, and Blood Institute [National Institutes of Health] (NHLBI) (2)
National Human Genome Research Institute [National Institutes of Health] (NHGRI) (1)
National Institute for Children's Health Quality (NICHQ) (1)
National Institute for Occupational Safety and Health [Centers for Disease Control and Prevention] (CDC NIOSH) (10)
National Institute of Allergy and Infectious Diseases [National Institutes of Health] (NIAID) (1)
National Institute of Child Health and Human Development [National Institutes of Health] (NICHD) (2)
National Institute of Environmental Health Sciences [National Institutes of Health] (NIEHS) (8)
National Institute of Mental Health [National Institutes of Health] (NIMH) (3)
National Institute of Neurological Disorders and Stroke [National Institutes of Health] (NINDS) (1)
National Institute on Aging (NIA) (2)
National Institute on Drug Abuse (NIDA) (2)
National Institutes of Health (NIH) (11)
National Integrated Health Associates (NIHA) (1)
National Jewish Health (1)
Natural Hazards Center [University of Colorado at Boulder] (1)
New York State Department of Health (1)
New York University (NYU) (2)
New Zealand Government, Ministry of Social Development (1)
North Carolina Department of Health and Human Services (1)
North Carolina Institute of Public Health [University of North Carolina, Gillings School of Global Public Health] (NCIPH) (1)
Northwestern University (4)
Nottingham Trent University (1)
OQ Measures (1)
Occupational Safety and Health Administration [U.S. Department of Labor] (OSHA) (1)
Ohio State University (OSU) (1)
Oklahoma State Department of Health (3)
Old Dominion University (1)
Optum, Inc. (3)
Oregon State University (2)
Orthopaedic Scores (1)
Pearson Assessments (12)
Pennington Biomedical Research Center [Louisiana State University] (PBRC) (1)
Pfizer, Inc. (2)
Prepare/Enrich Insights (1)
Princeton University (1)
Prosthetics Research Study (PRS) (1)
Psychological Assessment Resources, Inc. (PAR) (7)
Psychology Foundation of Australia (1)
QOL Tech (2)
RAND Corporation (12)
RP Group (1)
Radboud University Medical Center (2)
Rare Diseases Clinical Research Network [National Center for Advancing Translational Sciences] (RDCRN) (2)
Resilience Center (1)
River Centre Foundation (1)
SKB (1)
Save the Children International (1)
Spectrum Assessments (1)
St. George's, University of London (SGUL) (1)
St. James University Hospital (1)
Stanford University (5)
Trier University (1)
Trinity College Dublin (1)
Tulane University (3)
U Conn Health (1)
U.S. Census Bureau (1)
U.S. Department of Agriculture (USDA) (1)
U.S. Department of Defense (DOD) (9)
U.S. Department of Defense, Defense Health Agency (DHA) (1)
U.S. Department of Homeland Security (DHS) (1)
U.S. Department of Veterans Affairs (VA) (2)
U.S. Environmental Protection Agency (EPA) (1)
U.S. National Response Team (NRT) (1)
UT Health Rio Grande Valley (1)
United Kingdom Department of Health (DH) (1)
Universidade do Porto (1)
University Medical Center Groningen (UMCG) (1)
University of Arizona (1)
University of Auckland (1)
University of Bergen (1)
University of California, Berkeley (4)
University of California, Davis (3)
University of California, Los Angeles (UCLA) (2)
University of California, Los Angeles, UCLA Center for Public Health and Disasters (7)
University of California, Riverside (UCR) (1)
University of California, San Diego (UCSD) (3)
University of California, San Francisco (UCSF) (5)
University of Cambridge (1)
University of Central Florida (UCF) (1)
University of Connecticut School of Medicine (1)
University of Denver (DU) (2)
University of Edinburgh (2)
University of Florida (UF) (2)
University of Illinois at Chicago, School of Public Health (1)
University of Illinois at Urbana-Champaign (1)
University of Iowa (UI) (4)
University of Melbourne (1)
University of Miami (UM) (8)
University of Michigan (6)
University of Minnesota (1)
University of Missouri (MU) (2)
University of Montana (1)
University of Nebraska Medical Center (UNMC) (1)
University of New Hampshire (UNH) (1)
University of New Mexico (UNM) (1)
University of New Orleans (1)
University of North Carolina at Chapel Hill (UNC) (3)
University of North Carolina, Gillings School of Global Public Health (1)
University of Nottingham (1)
University of Oklahoma (1)
University of Oklahoma Health Sciences Center (2)
University of Oregon (UO) (1)
University of Pennsylvania (3)
University of Pittsburgh (5)
University of Queensland (1)
University of South Alabama (1)
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University of Texas McGovern Medical School (1)
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University of Texas at Austin (1)
University of Texas, MD Anderson Cancer Center (1)
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University of Washington (UW) (3)
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University of Wisconsin-Madison (UW) (1)
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Université de Montréal (1)
Vanderbilt University Medical Center (VUMC) (1)
Virginia Tech University (1)
Washington University in St. Louis (WUSTL) (3)
Wellcome Trust (1)
Western Psychological Services (2)
Winterberry Press (1)
World Health Organization (WHO) (12)
World Health Organization, Regional Office for Europe (1)
Yale University (1)

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- New York State Department of Health Community Reception Center (CRC) Form

Source: New York State Department of Health

Format: PDF

Annotation: The New York State Department of Health Community Reception Center (NYSDOH CRC) form is the product of the New York State Department of Health, Center for Environmental Health, and Countermeasure and Response Administration (CRA) system that was developed by the Centers for Disease Control and Prevention (CDC) to support all hazards countermeasure tracking for any countermeasure and any event. The NYSDOH CRC questionnaire form contains items pertaining to potential radiation routes of contamination, contact information and demographics, exposure information, clinical symptoms, and medical history. This resource was identified by the NIH Disaster Research Response Program (DR2) for researchers looking for pre- and post-disaster data collection instruments.

Ease of Use in Disaster Setting: Easy
Population: All/Anyone
Length: 16 questions, four sections
Administered by: Self Administered/Self Report, Specialist/Doctor/Expert
Language(s): English...[See more] [See less]

URL: https://www.remm.nlm.gov/Empire-09-Tracking-and-Epi-form-FINAL.pdf

Type: Guideline/Assessment Tool

Access Notes: Free/Publicly Available

Citation(s):
Currently, there are no available publications that address the use of this tool or data gathered from this measure.

Contact information:

Institution: Centers for Disease Control and Prevention
Address: 1600 Clifton Road NE, Atlanta, Georgia 30333
Phone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
Email: cdcinfo@cdc.gov, ctshelp@cdc.gov, crahelp@cdc.gov
Web: https://www.cdc.gov; https://www.cdc.gov/csels/dhis/cra/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fophss%2Fcsels%2Fdhis%2Fcra%2Findex.html

Institution: Oak Ridge Institute for Science and Education
Web: https://www.orau.gov/rsb/vcrc/; https://www.orau.gov/rsb/vcrc/508/index.asp?p=0

Institution: New York State Department of Health
Address: Corning Tower, Empire State Plaza, Albany, NY 12237
Email: dohweb@health.state.ny.us

Includes Research Tools: Yes.

ID: 8650. From: Disaster Lit^®a database of the U.S. National Library of Medicine.

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NIH Public Health Emergency and
Disaster Research Response (DR2)

COVID-19 Information

Refine Your Results

Data Collection on

COVID-19 Main Topics

Publication Type

Source

REDCap

Results from:

NIH Public Health Emergency and Disaster Research Response (DR2)

COVID-19 Information

Refine Your Results

Data Collection on

COVID-19 Main Topics

Publication Type

Source

REDCap

Results from:

NIH Public Health Emergency and
Disaster Research Response (DR2)