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Company IgG / Virology Research Laboratory / / Country Australia / / Facility PLEASE RETURN THIS FORM EVEN IF ALL THE SECTIONS HAVE NOT BEEN COMPLETED Beverley Hall / Wales Hospital / Clinical Sciences Building / Name Hospital / / / MedicalCondition fever / congenital infections / Petechiae / purpura Yes No DK / illness / rash / / Organization Name Hospital / Wales Hospital / / Person Torres Strait Islander / Aboriginal / Cord Blood / Beverley Hall Prince / Prince / / / Position physician / Prince / / Product M-9 / / SocialTag 
Congenital Cytomegalovirus (CMV) Infection Questionnaire Australian Paediatric Surveillance Unit If you wish to discuss this questionnaire please contact Study Co-ordinator, Beverley Hall Prince of Wales Hospital, High S