By
HealthMap
Disease Tracking and Reporting System
Reports to be uploaded:
0
Pt ID:
Date:
Location:
Region:
|
Shelter:
House
Tent
None
Age/Sex:
Choose disease category:
Cholera »
Diarrhea
Muscle pain/cramps
Nausea
Malaria »
Rapid test
Smear positive
Typhoid »
Perforation
fever
abdominal pain
clinical perforation
Titer positive
fever
abdominal pain
Widal test/titer positive
Syndrome
fever
abdominal pain
Malaria negative
Meningitis »
fever
altered mental status
neck stiffness
HIV positive
HIV negative
Tuberculosis »
cough
fever
weight loss x 3 wks or greater
CXR c/w TB
extrapulmonary
pleural effusion
miliary
HIV coinfection
AFB positive
AFB negative
HIV »
new diagnosis
Diphtheria »
severe throat pain
fever
+ neck swelling and throat membranes
- neck swelling
Tetanus »
tetanus
Or
Syndrome »
fever
hepatomegaly
splenomegaly
vesicular rash
non-vesicular rash
abdominal pain
respiratory symptoms
diarrhea
body aches
hepatitis or icterus
anemia
eosinophilia
HIV positive
elevated creatinine
neurologic deficit
Notes »
