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Immediate national notifiable condition:Find:Pt:^Event:Ord:
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Country of origin:Loc:Pt:^Patient:Nom:
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Country of usual residence
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Reporting state:Loc:Pt:^Event:Nom:
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Reporting county:Loc:Pt:^Event:Nom:
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National reporting jurisdiction:Loc:Pt:^Event:Nom:
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Jurisdiction code:ID:Pt:^Event:Nom:
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Date of initial report:TmStp:Pt:^Event:Qn:
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{mm/dd/yyyy}
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Source of info
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Postal code Facility
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Earliest date reported to county:TmStp:Pt:^Event:Qn:
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{mm/dd/yyyy}
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Earliest date reported to state:TmStp:Pt:^Event:Qn:
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{mm/dd/yyyy}
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Hospitalized for condition
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Hospital admission date
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Hospital discharge date
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Hosp stay duration
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d
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Earliest Date of Dx
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{mm/dd/yyyy}
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Illness or injury onset date and time
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Illness or injury end date
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{mm/dd/yyyy}
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Illness duration
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d
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Pt died from illness
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Date of death
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Case investigation start date:Date:Pt:^Event:Qn:
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{mm/dd/yyyy}
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Case is associated with a known outbreak:Find:Pt:^Event:Ord:
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Case outbreak name:ID:Pt:^Event:Nom:
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Jurisdiction where disease acquired:Loc:Pt:^Patient:Nom:
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Country exp to illness
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St or Prov exposure to illness
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City of exposure to illness
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Co. of exposure to illness
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Binational reporting criteria:Type:Pt:^Event:Nom:CDC.PHIN
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Disease transmission mode
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Case class status:Type:Pt:^Event:Nom:CDC.PHIN
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Week counted for Morbidity and Mortality Weekly Report:Num:Pt:^Event:Qn:CDC.PHIN
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{#}
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Year included in Morbidity and Mortality Weekly Report:Date:Pt:^Event:Qn:CDC.PHIN
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{yyyy}
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State notifiable condition case identifier:ID:Pt:^Event:Nom:
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Date of first report to Centers for Disease Control and Prevention:TmStp:Pt:^Event:Qn:CDC.PHIN
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{mm/dd/yyyy}
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Date of first report to public health department:TmStp:Pt:^Event:Qn:
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{mm/dd/yyyy}
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Preg stat at illness cond
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Reporter of adverse event or unsafe condition:Pn:Pt:^Event:Nom:
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Reporter phone number:Tele:Pt:^Event:Nom:
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Reporter email:EmailAddr:Pt:^Event:Nom:
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Legacy case identifier:ID:Pt:^Event:Nom:CDC.PHIN
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Age at time of case investigation:Time:Pt:^Patient:Qn:
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a
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Case notification comment:Imp:Pt:^Event:Nom:
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