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Documenation prev rubella tx
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Y prev tested for rubella immun
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{yyyy}
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Prev rubella virus tx result
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Mother Recvd vaccine for illness
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Date+time of vaccination
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Type Vaccine
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Manufacturer name Vaccine
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Lot # Vaccine
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# previous doses
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{#}
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Reason vacc not recvd
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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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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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Setting of exposure to illness
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Age and setting of exposure to illness verified:Find:Pt:^Patient:Ord:
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GA (weeks)--at cess of preg
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wk
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