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First Name: ___ Last Name: ___Phone: ___ Email: ___Have you experienced any of the following symptoms in the last 7 days? Had a fever? YesNo Cough or sore throat? YesNoShortness of breath / Difficulty
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The surveillance form during disease is a document used to collect and record data on cases of specific diseases to monitor and control outbreaks.
Healthcare providers, laboratories, and certain public health officials are typically required to file surveillance forms during disease outbreaks.
To fill out a surveillance form during disease, gather relevant patient information, clinical details, test results, and complete all sections of the form as specified by health authorities.
The purpose of the surveillance form during disease is to track the incidence and spread of diseases, inform public health responses, and aid in research and preventive measures.
Information that must be reported includes patient demographics, symptoms, diagnosis, treatment, laboratory results, and any epidemiological data related to the disease.
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