13.07.2015 Views

The Management of Viral Haemorrhagic Fevers in Ireland - Health ...

The Management of Viral Haemorrhagic Fevers in Ireland - Health ...

The Management of Viral Haemorrhagic Fevers in Ireland - Health ...

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

VHF High Risk Contact Surveillance Form v1.0Page 4 <strong>of</strong> 4Section D - OutcomeSurveillance <strong>of</strong> OutcomePlease tick as appropriatePatient rema<strong>in</strong>ed wellPatient diagnosed with VHFPatient lost to follow-upPatient diagnosed with illness other than VHFIf patient diagnosed with illness other than VHFDiagnosis:DateIf patient diagnosed with VHF, date <strong>of</strong> diagnosisCIDR Event IDCIDR Outbreak IDCommentsAppendix M: VHF Contact Surveillance Formm <strong>The</strong> <strong>Management</strong> <strong>of</strong> <strong>Viral</strong> <strong>Haemorrhagic</strong> <strong>Fevers</strong> <strong>in</strong> <strong>Ireland</strong>/HPSC 2012SignatureDateFor High Risk Contacts only- 112 -

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!