Beruflich Dokumente
Kultur Dokumente
ACUTE FLACCID PARALYSIS, MEASLES AND AEFI SURVEILLANCE SYSTEM - WEEKLY HOSPITAL REPORT
After review of all wards and registry books, please send this report to the following person every Monday.
Name: ________________________________________________________________________________________
Address: ______________________________________________________________________________________
Fax: ____________________________
Year:
Week No.
AFP*
From:
To:
Suspected Measles**
AEFI*** Serious
Severe
Write the case details of AFP cases identified and reported this week
Patient's name
and
Father's name
Age in
months
Sex
PHC name
District name
Block name
Block name
District name
* All cases of AFP in children under 15 years of age should be reported and investigated per guidelines.
** All cases of suspected measles of any age should be reported and investigated per guidelines.
***All cases of serious/severe AEFI should be reported and investigated per guidelines.
Outcome:
Died?
#
(Y/N/U)
Form VPD-D001
ACUTE FLACCID PARALYSIS, MEASLES AND AEFI SURVEILLANCE SYSTEM - WEEKLY DISTRICT REPORT
Address:_____________________________________________________
Year:
Week No:
From:
To:
Fax:_______________________
AFP:
AEFI***:
Serious
Severe
Write EPID numbers of AFP cases identified and reported this week:
Number of Cases
Number of Deaths
Number of Cases
Number of Deaths
Blocks within
the reporting
district
District total:
Note:
Block name
Form VPD-S001
ACUTE FLACCID PARALYSIS, MEASLES AND AEFI SURVEILLANCE SYSTEM - WEEKLY STATE REPORT
Address:_____________________________________________________
Year:
Week No:
From:
To:
Fax:_______________________
AFP:
AEFI***:
Serious
Severe
Write EPID numbers of AFP cases identified and reported this week:
Block name
Number Number
of Cases of Deaths
Block name
Number Number
of Cases of Deaths
If No, give
reason
Blocks within
the reporting
state
State total:
Note:
District name
If No, give
reason