daily outbreak status report - health...
TRANSCRIPT
Line Listing – Respiratory Daily Status Report Please complete and fax to the Leeds, Grenville and Lanark District Health Unit by 10:00 a.m. each day.
Secure Fax Line # 613-345-5777
The information contained in this facsimile message is intended only for the use of the recipient named above and may be confidential. Any other use, disclosure, or copying of this facsimile is strictly prohibited. If you have received this facsimile in error, please immediately notify us by telephone at 1-800-660-5853 or 613-345-5685 so that we may arrange the return of the original transmission. Thank you. Respiratory Line Listing_jan 2019 E
Date: Outbreak Number: 2243- Contact Name: Number of Pages: Institution Name: Choose one only: Staff Data Resident Data Case Definition - Any resident or staff member with illness onset from (date): who is experiencing any two of the following symptoms:
Case Identification Symptoms Specimens/ Diagnosis Prophylaxis/Treatment Complications
Cas
e N
umbe
r (s
eque
ntia
lly) Name & Location
(Floor, Room) G
ende
r (F/
M)
Dat
e of
Birt
h (y
yyy/
m/d
)
Ons
et d
ate
of fi
rst
sym
ptom
s (d
ate
m/d
) A
bnor
mal
tem
pera
ture
ºC
C
ough
(dry
) Pr
oduc
tive
coug
h (n
ew)
Nas
al c
onge
stio
n /
stuf
fy n
ose
Sore
thro
at
Hoa
rsen
ess
/ Diff
icul
ty
swal
low
ing
Chi
lls
Mya
lgia
(so
re
mus
cles
) M
alai
se /
Fatig
ue
Run
ny n
ose
/ sne
ezin
g
Hea
dach
e
Poor
app
etite
O
ther
(i.e
. sho
rtne
ss
of b
reat
h)
Nas
opha
ryng
eal s
wab
(d
ate
m/d
)
Res
ult (
date
m/d
)
Tam
iflu
Tre
atm
ent
Dos
e
(dat
e m
/d)
Tam
iflu
Prop
hyla
xis
(dat
e m
/d)
Flu
vacc
ine
(dat
e m
/d)
Pneu
mov
ax v
acci
ne
(dat
e m
/d)
Ant
ibio
tic (d
ate
m/d
)
Bro
nchi
tis (d
ate
m/d
)
Pneu
mon
ia c
onfir
med
by
Che
st X
-Ray
H
ospi
taliz
atio
n (d
ate
m/d
)
Dea
th (d
ate
m/d
)
Line Listing – Respiratory Daily Status Report Please complete and fax to the Leeds, Grenville and Lanark District Health Unit by 10:00 a.m. each day.
Secure Fax Line # 613-345-5777
The information contained in this facsimile message is intended only for the use of the recipient named above and may be confidential. Any other use, disclosure, or copying of this facsimile is strictly prohibited. If you have received this facsimile in error, please immediately notify us by telephone at 1-800-660-5853 or 613-345-5685 so that we may arrange the return of the original transmission. Thank you. Respiratory Line Listing_jan 2019 E
Date: Outbreak Number: 2243- Contact Name: Number of Pages: Institution Name: Choose one only: Staff Data Resident Data Case Definition - Any resident or staff member with illness onset from (date): who is experiencing any two of the following symptoms:
Case Identification Symptoms Specimens/ Diagnosis Prophylaxis/Treatment Complications
Cas
e N
umbe
r (s
eque
ntia
lly) Name & Location
(Floor, Room) G
ende
r (F/
M)
Dat
e of
Birt
h (y
yyy/
m/d
)
Ons
et d
ate
of fi
rst
sym
ptom
s (d
ate
m/d
) A
bnor
mal
tem
pera
ture
ºC
C
ough
(dry
) Pr
oduc
tive
coug
h (n
ew)
Nas
al c
onge
stio
n /
stuf
fy n
ose
Sore
thro
at
Hoa
rsen
ess
/ Diff
icul
ty
swal
low
ing
Chi
lls
Mya
lgia
(so
re
mus
cles
) M
alai
se /
Fatig
ue
Run
ny n
ose
/ sne
ezin
g
Hea
dach
e
Poor
app
etite
O
ther
(i.e
. sho
rtne
ss
of b
reat
h)
Nas
opha
ryng
eal s
wab
(d
ate
m/d
)
Res
ult (
date
m/d
)
Tam
iflu
Tre
atm
ent
Dos
e
(dat
e m
/d)
Tam
iflu
Prop
hyla
xis
(dat
e m
/d)
Flu
vacc
ine
(dat
e m
/d)
Pneu
mov
ax v
acci
ne
(dat
e m
/d)
Ant
ibio
tic (d
ate
m/d
)
Bro
nchi
tis (d
ate
m/d
)
Pneu
mon
ia c
onfir
med
by
Che
st X
-Ray
H
ospi
taliz
atio
n (d
ate
m/d
)
Dea
th (d
ate
m/d
)