has component is about vaccination procedure questionnaire for University of Maryland College Park vaccination consent screening questionnaire for UM College Park smallpox vaccination consent http://www.health.umd.edu/sites/default/files/Smallpox-History-WebForm_1.pdf smallpox vaccination question whether currently sick question whether allergic to latex question on long-term heart disease question on cancer question on leukemia question on AIDS prednisone treatment question steroids treatment question question on current anti-cancer drug usage question on woman pregnancy now or during the next month question on whether having atopic dermatitis question on stroke leading brain or nerve damage question on woman's possibility of geting pregnant question on agammaglobulinemia question on lymphoma question on SLE question on drug usage after organ transplant question on autoimmune disease drug usage question on current condition leads to skin break question onwhether having skin rash question on whethere having severe burn question on whether having impetigo question whether having chickenpox question on whether having shingles question on whether having herpes question on whether having psoriasis question on whether having severe acne question on Darier's disease question on whether using steroid eye drop question on whether diagnosed with myocardial infarction question on whether diagnosed with angina question on whether diagnosed with congestive heart failure question on whether diagnosed with cardiomyopathy question on whether had transient ischemic attack question on chest pain question on shortness of breath when exert question whether allergic to smallpox vaccine question whether allergic to polymixin B question whether allergic to streptomycin question whethere allergic to chlortetracycline question whethere allergic to neomycin question on last month's sexual intercourse without effecctive birth control question on sexual intercourse without effecctive birth control after the vaccination question whether live with a child less than one year old question whether current breast-feeding question for household memeber of vaccination patient question on current medication usage question whether had organ transplant