2022 U.S. monkeypox outbreak short case report form

Details

• Corporate Authors:
  Centers for Disease Control and Prevention (U.S.)
• Description:
  Instructions for State, Local, and Territorial Health Jurisdictions: This form is an aid for public health officials when collecting essential data elements needed for investigating and reporting probable or confirmed monkeypox cases to CDC as part of the 2022 U.S. Monkeypox Outbreak response. Local public health officials may choose to use this fillable PDF for data collection within their jurisdiction, but data submission to CDC should be through established case surveillance systems and not through individually completed forms. Case information should always be captured electronically to minimize transcription errors; however, this form may be printed if needed. ; Form Approved ; OMB No. 0920-1011 ; Exp. Date 01/31/2023 ; Short Case Report Form 2022 Monkeypox Outbreak ; Sensitive but Unclassified ; sCRF-Short-Form.pdf
• Subjects:
  • Disease Notification
  • Mpox (monkeypox)
  • Population Surveillance
  • Public Health
• Document Type:
  Pamphlet (or booklet)
• Genre:
  Forms
• Place as Subject:
  United States
• Download URL:
  https://stacks.cdc.gov/view/cdc/123244/cdc_123244_DS1.pdf
• File Type:
  [PDF - 826.36 KB]
• Collection(s):
  Stephen B. Thacker CDC Library
• Main Document Checksum:
  urn:sha256:eab93e954570d4ab9d28144b8f3261513109e90c45c772abe6947076cac0c6fa