Instructions for completing the AFM patient summary form
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Instructions for completing the AFM patient summary form

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      CDC requests that state health departments send the Patient Summary Form, along with additional clinical information, to CDC for case classification and to help monitor these cases at the national level. AFM neurology experts will classify suspect cases of AFM according to the Council of State and Territorial Epidemiologists (CSTE) AFM case definition using the requested clinical information: admission and discharge notes, MRI report, MRI images, neurology consult notes, infectious disease consult notes, vaccination record, diagnostic laboratory results, and EMG report if done and available. When sending this information, please indicate the information included with the Patient Summary Form in the box at the top of the form. patient-summary-form-instructions.pdf
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