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    P & L Forms

    Uploaded by

    Swagat Gudagudi
    This document contains two forms for weekly reporting of disease surveillance data - Form P and Form L. Form P is for reporting case numbers from an institution in Karnataka, including demographic details and counts of various diseases seen as outpatients. Form L is for a laboratory to report the number of samples tested and positives found for different diseases. It also includes a line list of confirmed positive cases, excluding malaria and HIV.

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    Download as DOC, PDF, TXT or read online from Scribd

    P & L Forms

    Uploaded by

    Swagat Gudagudi
    89 views2 pages
    This document contains two forms for weekly reporting of disease surveillance data - Form P and Form L. Form P is for reporting case numbers from an institution in Karnataka, including demographic details and counts of various diseases seen as outpatients. Form L is for a laboratory to report the number of samples tested and positives found for different diseases. It also includes a line list of confirmed positive cases, excluding malaria and HIV.

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    This document contains two forms for weekly reporting of disease surveillance data - Form P and Form L. Form P is for reporting case numbers from an institution in Karnataka, including demographic details and counts of various diseases seen as outpatients. Form L is for a laboratory to report the number of samples tested and positives found for different diseases. It also includes a line list of confirmed positive cases, excluding malaria and HIV.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    89 views2 pages

    P & L Forms

    Uploaded by

    Swagat Gudagudi
    This document contains two forms for weekly reporting of disease surveillance data - Form P and Form L. Form P is for reporting case numbers from an institution in Karnataka, including demographic details and counts of various diseases seen as outpatients. Form L is for a laboratory to report the number of samples tested and positives found for different diseases. It also includes a line list of confirmed positive cases, excluding malaria and HIV.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    FORM P

    (Weekly Reporting Format –IDSP)

    Name of Reporting Institution: I.D. No.:


    State: Karnataka District: Belgaum Block/Town/City:
    Name of MOH Signature:
    IDSP Reporting Week:- Start Date:- End Date:- Date of Reporting:-

    No. of cases
    Diseases / Male Female
    Syndromes Total
    <5 ≥5 Total <5 ≥5 Total
    yrs yrs yrs yrs
    Malaria
    Measles
    Chicken Pox
    Dengue / DHF / DSS
    Chikungunya
    Meningitis
    Acute Encephalitis Syndrome
    Enteric Fever
    Fever of Unknown Origin (PUO)
    Diphtheria
    Pertussis
    Acute Respiratory Infection
    (ARI) / Influenza Like Illness (ILI)
    Pneumonia
    Acute Diarrhoeal Disease
    (including acute gastroenteritis)
    Bacillary Dysentery
    Viral Hepatitis
    Leptospirosis
    Acute Flaccid Paralysis
    < 15 Years of Age
    Any other State Specific
    Disease
    (Specify)
    Unusual Syndromes NOT
    Captured Above (Specify clinical
    diagnosis)
    Total New OPD attendance (Not
    to be filled up when data
    collected for indoor cases)
    Action taken in brief if unusual
    increase noticed in cases/deaths
    for any of the above diseases
    Dog bite
    Snake bite
    FORM L
    (Weekly Reporting Format – IDSP)
    Name of the Laboratory: Institution:
    State: Karnataka District: Belgaum Block/Town/City:
    Name of MOH Signature:

    IDSP Reporting Week:- Start Date:- End Date:- Date of Reporting:-

    Diseases No. Samples No. found Positive


    Tested
    Male Female Total
    Dengue / DHF / DSS
    Chikungunya
    JE
    Meningococcal Meningitis
    Typhoid Fever
    Diphtheria
    Cholera
    Shigella Dysentery
    Viral Hepatitis A
    Viral Hepatitis E
    Leptospirosis
    Malaria PV: PF: PV: PF: PV: PF:
    AFB / T.B
    HIV
    Other (Specify)
    Other (Specify)

    Line List of Positive Cases (Except Malaria & HIV+ve cases):


    Name Age Sex Address: Name of Test Done Diagnosis
    (Yrs) (M/F) Village/Town (Lab
    confirmed)

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