Influenza-like Ilnness (ILI) Line List for Long-Term …

Influenza-like illness (ILI) line List Facility _____ For Long-Term care facilities Use this 2-page form to collect data. Complete both pages for each resident with ILI. Dates _____ Lab Results Vaccine Status (date) Symptoms (Y/N/U) ILI Other Name Room No. Age Sex (M/F) influenza pneumococcal Onset Date of ILI Symptoms Duration (days) Highest Temp myalgia headache sore throat cough chills coryza other viral culture rapid test H1N1 (commercial lab) H1N1 (MDH lab) viral culture bacterial culture 1. 2.

Influenza-like Illness (ILI) Line List Facility _____ For Long-Term Care Facilities Use this 2-page form to collect data. Complete both pages for each resident with ILI.

Tags:

  Terms, Line, Care, Long, Facilities, Illness, Influenza, Like, Influenza like ilnness, Ilnness, For long term care facilities

Information

Related search queries