|
|
|
Appendix
Background Information Required for Student Exercises
*Exercise 3: Case Report Forms
State
Disease Report Form
| State
Disease Report Form |
Name
McDowell, D. |
Age
33 |
Phone
555-3707 |
Address
2020 Alabama |
Sex
M |
Race
W |
City,
State
Columbia |
County
Columbia |
Disease
Trichinosis |
Date
of Onset
7/27 |
Lab
Confirmation
Muscle Biopsy |
Hospital
Alerted?
Yes |
Hospital
Name
Columbia General |
Admission
Date
7/27 |
Discharge
Date |
Lab
Test Results
Eosinophilia = 2500 |
Comments
(Clinical description, immunization theory, etc.) |
Possible
Exposure Cleveland-McKay
Wedding
|
Physician
Reporting
Dr. Baker |
Phone
555-1900 |
Date
of Report
8/17 |
| State
Disease Report Form |
Name
Gordon, Jack |
Age
26 |
Phone
555-1213 |
Address
110 Clifton St. |
Sex
M |
Race
W |
City,
State
Columbia |
County
Columbia |
Disease
Probable Trichinosis |
Date
of Onset
8/14 |
Lab
Confirmation
Not Done |
Hospital
Alerted?
No |
Hospital
Name |
Admission
Date |
Discharge
Date |
Lab
Test Results
Eosinophilia = 37% |
Comments
(Clinical description, immunization theory, etc.) |
Possible Exposure
Cleveland-McKay Wedding
|
Physician
Reporting
Dr. Gibbs |
Phone
555-3841 |
Date
of Report
8/14 |
| State
Disease Report Form |
Name
Thomas, Nancy |
Age
27 |
Phone
555-3761 |
Address
2020 Alabama |
Sex
F |
Race
W |
City,
State
Columbia |
County
Columbia |
Disease
Trichinosis |
Date
of Onset
8/4 |
Lab
Confirmation
Not Done |
Hospital
Alerted?
No |
Hospital
Name |
Admission
Date |
Discharge
Date |
Lab
Test Results
Eosinophilia = 18% |
Comments
(Clinical description, immunization theory, etc.) |
Possible Exposure
Cleveland-McKay Wedding
|
Physician
Reporting
Dr. Stanley |
Phone
555-0400 |
Date
of Report
8/14 |
| State
Disease Report Form |
Name
Dickens, R. |
Age
43 |
Phone
555-2662 |
Address
34 Whinfred Ave. |
Sex
M |
Race
W |
City,
State
Seattle, WA |
County
King |
Disease
Trichinosis |
Date
of Onset
7/25 |
Lab
Confirmation
Serologic |
Hospital
Alerted?
No |
Hospital
Name |
Admission
Date |
Discharge
Date |
Lab
Test Results
Eosinophilia = 4100 |
Comments
(Clinical description, immunization theory, etc.) |
Possible Exposure
Cleveland-McKay Wedding
|
Physician
Reporting
Dr. Webster |
Phone
555-0511 |
Date
of Report
8/15 |
| State
Disease Report Form |
Name
McKay, Alice |
Age
54 |
Phone
555-6256 |
Address
406 Tugalo Ln. |
Sex
F |
Race
W |
City,
State
Brighton |
County
Clayton |
Disease
R/O Trichinosis |
Date
of Onset
8/14 |
Lab
Confirmation
Not Done |
Hospital
Alerted?
Yes |
Hospital
Name
Columbia General |
Admission
Date
8/14 |
Discharge
Date |
Lab
Test Results
Eosinophilia = 3600 |
Comments
(Clinical description, immunization theory, etc.) |
Possible Exposure
Cleveland-McKay Wedding
|
Physician
Reporting
Dr. Mason |
Phone
555-3291 |
Date
of Report
8/15 |
| |
Rash |
No
Rash |
Total |
|
Exposed to
Celery? |
Yes |
25 |
31 |
56 |
| No |
5 |
65 |
70 |
| |
Total |
30 |
96 |
126 |
*Exercise 5: Data
on exposure to celery
Back to How to Investigate an
Outbreak
|
|
