DAILY DENGUE FEVER CASES REPORT FORMAT-I

dharmapuri

TOTAL NO.OF IP NO.OF FEVER CASES NO.OF FEVER CASES TOTAL NO.OF IP DENGUE +VE CASES TOTAL NO.OF IP NO.OF DENGUE NO.OF DENGUE DENGUE +VE CASES
FEVER CASES IN ADMITTED THIS DISCHARGED THIS FEVER CASES IN IN HOSPITAL (OUT FEVER CASES IN CASES DETECTED IN CASES DISCHARGED (OUT OF IP) END Dengue Cases Died
NAME OF HOSPITALS HOSPITALS END OF OF TOTAL) HOSPITALS
PREVIOUS DAY DAY DAY TODAY PREVIOUS DAY PREVIOUS DAY THIS DAY THIS DAY OF THIS DAY
THE
HOSPITAL

<12 <12 <12 <12 <12 ELISA ELISA ELISA ELISA <12
ADULT TOTAL ADULT TOTAL ADULT TOTAL ADULT TOTAL ADULT TOTAL ADULT TOTAL
CHILD CHILD CHILD CHILD CHILD CHILD
NS1 Igm TOTAL NS1 Igm TOTAL NS1 Igm TOTAL NS1 Igm TOTAL
1.4.19 2 6 8 0 2 2 0 1 1 2 7 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2.4.19 2 7 9 2 1 3 2 2 4 2 6 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 3.4.19 2 6 8 1 0 1 1 1 2 2 5 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 4.4.19 2 5 7 1 1 2 0 0 0 3 6 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 5.4.19 3 6 9 3 1 4 1 5 6 5 2 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 6.4.19 5 2 7 2 0 2 0 0 0 7 2 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 7.4.19 7 2 9 0 0 0 0 1 1 7 1 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 8.4.19 7 1 8 0 1 1 2 1 3 5 1 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
9 9.4.19 5 1 6 0 3 3 3 0 3 2 4 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 10.4.19 2 4 6 0 1 1 1 1 2 1 4 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
11
12
13
14
15
16

MEDICAL OFFICER
GOVERNMENT HOSPITAL
PAPPIREDDIPATTI
 DAILY REPORT- ADMISSION CASES
NAME OF THE DISTRICT : DATE OF REPORTING :
S.N DATE OF CONTACT NAME OF THE
NAME AGE(Yrs) SEX (M/F) ADDRESS:VILLAGE/TOWN Pincode DIAGNOSIS;CONDITION REMARKS IF ANY
O ADMISSION NUMBER HOSPITAL/INSTITUTION