Beruflich Dokumente
Kultur Dokumente
7. Travel history: Travel of child within 35 days prior to onset of paralysis (indicate dates and place of travel with arrows on dateline)
Write dates of travel: Day of onset
Write here places visited corresponding to the travel dates District of residence: ____________________________
Requires cross notification? Yes / No
If yes, date of cross notification: Block/ Urban area of residence: ___________________
8. History of contacts with healthcare providers after the date of paralysis onset ( including the notifying health facility):
Name & address of 1 2 3 4
Hospital/ doctor/ quack:
11. Contact stool: Was this case eligible for contact stool collection: Yes / No If yes, date collected: ______ / ______/ ______