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Instructions for completing the AFM patient summary form
  • Published Date:
    October 15, 2015
  • Language:
    English
Filetype[PDF-409.70 KB]


Details:
  • Alternative Title:
    Instructions for completing the acute flaccid myelitis patient summary form
  • Description:
    Clinicians should report all patients who meet the case definition (as specified on page 4) for AFM to their state or local health department using this Patient Summary Form.

    a. Clinicians should report patients who meet the case definition regardless of any laboratory results.

    b. This form should be completed by, or in conjunction with, a clinician who provided care to the patient during the neurologic illness.

    c. So that cases can be monitored in as real time as possible, this form should be submitted to the state or local health department as soon as possible after case identification.

    CDC requests that state health departments also submit the Patient Summary Form to CDC to help monitor these cases at the national level. A form that is largely complete but has some information pending (e.g., hospital or health department laboratory results) or under investigation (e.g., polio vaccination history) should still be submitted as soon as possible, and the pending results can then be provided to CDC when they become available.

    patient-summary-form-instructions.pdf

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