Mount Vernon / Reporting facility / ASSOCIATED WITH HOMELESS SHELTER / ASSOCIATED WITH OR INMATE OF CORRECTIONAL FACILITY / CLINIC ADDRESS NO YES YES UNK CHECK BELOW IF PATIENT / / /
IndustryTerm
sterile equipment / otitis media / Communicable Disease Prevention / food / energy / otoscopic equipment / Sterile medical devices / treatment of the disease / /
MedicalCondition
weekly aggregate influenza / MOTT infection / TB / Mabscesital otitis media / M. tuberculosis / headache / Mycobacterium Other Than Tuberculosis / II disease / Than Tuberculosis / Did Patient Die Of This Illness / patient’s disease / reported disease / communicable disease / Moth MOTT infections / mycobacteria tuberculosis / granulomatous inflammation / MS / infections / another disease / HIV infection / Occupational Diseases / multifocal bronchiectasis / Disease / Nontuberculosis Mycobacterium Lung Disease / reportable disease / fever / DATE(S) DATE RECEIVED SEVERITY OF VARICELLA SPECIFY TYPE OF BLOOD OR TISSUE AND FACILITY NAME/ADDRESS VACCINATION HISTORY FOR REPORTED CONDITION/DATES UNKNOWN Disease / then Tuberculosis / Diseases / nosocomial infection / serious and progressive illness / infection / post injection abscesses / DURATION (DAYS) DID PATIENT DIE OF THIS ILLNESS / MOTT infections / clinically compatible illness / Contents Mycobacterium Other Than Tuberculosis / surgical wound infections / cavitary disease / rash / varicella / human disease / Tuberculosis / /
Research Center / Dept of Health / Center for Disease Control / state health lab / TB State Health Lab / office of Surveillance / etc / Regional Health Office / Senior Services Communicable Disease Investigation Reference Manual Division of Environmental Health and Communicable Disease Prevention Section / American Public Health Association / American Thoracic Society / Division of Environmental Health and Communicable Disease Prevention Section / Committee on Infectious Diseases / National Jewish Medical and Research Center / American Academy of Pediatrics / Department of Health / / /
Position
HEALTH CARE WORKER / physician / Regional Communicable Disease Coordinator / submitting physician / REPORTER / physician / local public health agency / /
Mycobacteria Other Than Tuberculosis.doc