American Samoa / Nepal / Guam / Bangladesh / Cambodia / Thailand / Indonesia / Malaysia / Japan / Pakistan / United States / Vietnam / Korea / China / India / /
Facility
Other Residential Facility / Acute Care Facility / Laboratory Name Specimen Type / Correctional Facility / Laboratory Name Telephone Number LABORATORY RESULTS SUMMARY / Military Facility / LABORATORY INFORMATION LABORATORY RESULTS SUMMARY Specimen Type / Laboratory Local Health Jurisdiction Telephone Number Date / Homeless Shelter / LABORATORY CRITERIA FOR DIAGNOSIS Confirmatory / Long Term Care Facility / /
Public Health Center / Food Service / California Department / REMARKS REPORTING AGENCY / Drug Treatment Center / Infectious Diseases Division of Communicable Disease Control Infectious Diseases Branch Surveillance and Statistics Section / California Department of Public Health CHIKUNGUNYA CASE REPORT First / /
Person
Patient / /
Position
Investigator / farm worker / Manager / official / dental health worker / veterinarian / WBC HCT Hb / 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 / 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