American Samoa / Nepal / Guam / Bangladesh / Cambodia / Congo / Thailand / Indonesia / Malaysia / Japan / Pakistan / United States / Vietnam / Korea / China / India / /
Facility
Other Residential Facility / Acute Care Facility / Hospital Name / Correctional Facility / Laboratory Name / Military Facility / LABORATORY INFORMATION LABORATORY RESULTS SUMMARY / Homeless Shelter / Long Term Care Facility / / /
California Department of Public Health VIRAL HEMORRHAGIC FEVER CASE REPORT First / Public Health Center / Food Service / California Department / Drug Treatment Center / Infectious Diseases Division of Communicable Disease Control Infectious Diseases Branch Surveillance and Statistics Section / Electronic Filing Cabinet / /
Person
Patient / /
Position
Investigator / farm worker / Manager / official / dental health worker / veterinarian / Sex worker / Drug dealer / pharmacist / field worker / health care worker / Physician / paramedic / Manicurist / Laboratory technologist / Teacher /instructor / emergency medical technician / technician / Adult film actor/actress / hostess / proprietor / Police officer / sales worker / Teacher / Dentist / food preparation worker / medical assistant / animal control worker / nurse / worker / Homemaker / surgeon / prevention worker / migratory/seasonal worker / child care worker / physician assistant / unskilled worker / Craftsman / foreman / /
ProvinceOrState
Alaska / Hawaii / California / /
Region
North America / Middle East / North Africa / Central America / South America / Southeast Asia / Far East / /
State of California—Health and Human Services Agency Local ID Number ___________________________ California Department of Public Health Center for Infectious Diseases