(IPHS) Guidelines - NRHM Manipur

Annexure 7 A: Form P (Weekly Reporting Format-IDSP)Name of Reporting Institution:I.D. No.:State: District: Block/Town/City:Officer-in-Charge Name: Signature:IDSP Reporting Week: Start Date: End Date: Date of Reporting:__/__/____ __/__/____ __/__/____Sl. No. Diseases/Syndromes No. of cases1 Acute Diarrhoeal Disease (including acute gastroenteritis)2 Bacillary Dysentery3 Viral Hepatitis4 Enteric Fever5 Malaria6 Dengue/DHF/DSS7 Chikungunya8 Acute Encephalitis Syndrome9 Meningitis10 Measles11 Diphtheria12 Pertussis13 Chicken Pox14 Fever of Unknow Origin (PUO)15 Acute Respiratory Infection (ARI) Influenza Like lllness (ILI)16 Pneumonia17 Leptospirosis18 Acute Flaccid Paralysis < 15 year of Age19 Dog bite20 Snake bite21 Any other State Specific Disease (Specify)22 Unusual Syndromes NOT Captured Above (Specify clinical diagnosis)Total New OPD attendance (Not to be filled up when data collected for indoor cases)Action taken in brief if unusual increase noticed in cases/deaths for any of the abovediseases32Indian Public Health Standards (IPHS) Guidelines for Community health centres