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Company Suffix Maiden/Other Alias TRAVEL / IgG / Nurse Laboratory / / Country United States / / Facility (mm/dd/yyyy) / IndustryTerm transportation / telephone review / geographical site / aspirin-containing product / travel history / treatment for this illness / / MedicalCondition photophobia / Orchitis / Parotitis / mumps / serum mumps IgM / acute illness / N this disease / WIZARD COMMUNICABLE DISEASE Is/was / natural infection / U Headache / Deafness / lymphadenitis / U Thrombocytopenia / U Parotitis / U Arthritis / illness / hearing loss / Probable Acute parotitis / U Meningitis / temperature_____________ Fever / Aseptic meningitis Encephalitis Hearing loss / Aseptic meningitis / Acute parotitis / U this illness / disease / positive mumps / imported mumps / mumps virus / Mastitis / Autoimmune disease / Encephalitis / U Encephalitis / oophoritis / specific disease / Cough / / MedicalTreatment immunization / anti-rejection therapy / vaccination / / Movie Cause of death / / Organization Work Child Care School University/College Camp Doctor’s office / NC Private School / NC Public School / Duration / Person Source / / Position Physician Physician / Physician / disease Physician / school WORKER / final conclusions Hospital/physician / local health director CONTROL MEASURES Did / Teacher / nurse / verbal report Physician / child care worker / hospital/physician / assistant / / Product Date / / ProvinceOrState death / Technology Chemotherapy / genotype / / SocialTag 
Mumps Report Form - Part 2