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Get and Sign Evola Virus Disease EVD Contact Tracing Report Form

Get and Sign Evola Virus Disease EVD Contact Tracing Report Form

Use a Evola Virus Disease EVD Contact Tracing Report Form template to make your document workflow more streamlined.

FORM PART A EVD CASE INFORMATION Epi Case ID Surname Given Name City Province/Territory Phone number s PART B CONTACT INFORMATION NUMBER 1 Sex male/female Age years or months if under 2 years Date of Last Contact with EVD case dd/mm/yyyy Epidemiologic Risks High-risk/Low-risk Healthcare Worker yes/no If yes facility Quarantine Unique ID if applicable Postal Code EPIDEMIOLOGIC RISK High-risk Low-risk Living in the same household and having direct contact with a symptomatic EVD case such as...
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