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    Acute Hemorrhagic Fever - CRF

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    Mary Anne Grace Garrido
    This document appears to be a case report form used by the Philippine government for integrated disease surveillance and response. It collects information on patients such as name, age, sex, address, date of admission, date of onset of illness, and laboratory test results. It defines a case of acute hemorrhagic fever syndrome and notes that laboratory confirmation should be done if available. The form is used to monitor cases and aid in disease surveillance and response efforts in the Philippines.

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    Download as PDF, TXT or read online from Scribd

    Acute Hemorrhagic Fever - CRF

    Uploaded by

    Mary Anne Grace Garrido
    19 views1 page
    This document appears to be a case report form used by the Philippine government for integrated disease surveillance and response. It collects information on patients such as name, age, sex, address, date of admission, date of onset of illness, and laboratory test results. It defines a case of acute hemorrhagic fever syndrome and notes that laboratory confirmation should be done if available. The form is used to monitor cases and aid in disease surveillance and response efforts in the Philippines.

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    ACUTE HEMORRHAGIC FEVER.CRF

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    This document appears to be a case report form used by the Philippine government for integrated disease surveillance and response. It collects information on patients such as name, age, sex, address, date of admission, date of onset of illness, and laboratory test results. It defines a case of acute hemorrhagic fever syndrome and notes that laboratory confirmation should be done if available. The form is used to monitor cases and aid in disease surveillance and response efforts in the Philippines.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    19 views1 page

    Acute Hemorrhagic Fever - CRF

    Uploaded by

    Mary Anne Grace Garrido
    This document appears to be a case report form used by the Philippine government for integrated disease surveillance and response. It collects information on patients such as name, age, sex, address, date of admission, date of onset of illness, and laboratory test results. It defines a case of acute hemorrhagic fever syndrome and notes that laboratory confirmation should be done if available. The form is used to monitor cases and aid in disease surveillance and response efforts in the Philippines.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Philippine Integrated Disease Case Report Form

    Surveillance and Response


    Acute Hemorrhagic Fever Syndrome

    Region: ____________________________ Province: ___________________________ Municipality/City: ________________________________________


    Name of DRU: _________________________________________________________________ Type: ⃞RHU ⃞CHO ⃞Gov’t Hospital ⃞Private Hospital ⃞Clinic
    Address: ______________________________________________________ ⃞Private Laboratory ⃞Public Laboratory ⃞Seaport/Airport

    Date Admit- Blood


    Patient Date of Admit- Date onset PCR Re- Out-
    Patient’s Full Name Age Sex Complete Address ted?
    ted/seen/ Culture
    No. Birth of illness sult come
    consulted Result

    ___/___/___ ___/___/___ ___/___/___

    ___/___/___ ___/___/___ ___/___/___

    ___/___/___ ___/___/___ ___/___/___

    ___/___/___ ___/___/___ ___/___/___

    ___/___/___ ___/___/___ ___/___/___

    ___/___/___ ___/___/___ ___/___/___

    ___/___/___ ___/___/___ ___/___/___


    P - Positive
    Age: Indicate P - Positive A - Alive
    (specify
    D - days (specify organ- D - Died
    Response organism)
    Indicate First name, Middle name, M - months Specify Street/Purok/Subdivision, House #, Y - Yes ism) (specify
    Codes / mm/dd/yy mm/dd/yy mm/dd/yy N - Negative
    Last name Yr. - years Barangay, Municipality/City, Province N- No N - Negative date)
    Instructions ND - Not
    Sex:F - Female ND - Not done U - Un-
    done
    M - Male U - Unknown known
    U - Unknown

    Case Definition:
     Any hospitalized person with acute onset of fever of less than 3 weeks duration Note: Laboratory confirmation should be done if available
    and with any two of the following: hemorrhagic or purpuric rash, epistaxis, he-
    matemesis, hemoptysis, blood in stools, or other hemorrhagic symptom and the Case classification: Not applicable
    diagnosis is not Dengue

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