6.3.3.1. Forms

In addition to the Electronic Medical Record established at PHC Facilities for individuals, there are printed forms in use:

• Doctors Clinic Register (outpatients)
• Syndromic surveillance – Daily/weekly Tally Sheet: Health Center and Sentinel Site
• EPI Surveillance Form
• Hospital Communicable Disease Case Notification Form - For every inpatient with suspected or confirmed CD (only one notification form for suspect, probable and confirmed, that is updated after confirming or not in the same form).
• Laboratory Case Notification Form - For every outpatient with positive laboratory test for CD
• Laboratory Investigation Form CD Surveillance (Emerging Infectious Diseases)
• Laboratory request form (general)
• Laboratory requisition form for microbiology
• Laboratory report form (microbiology)
• CARPHA laboratory Investigation Form
• Case Investigation Form
• Outbreak Daily Tally Sheet
• Outbreak investigation reporting form
• HIV/AIDS Notification Form
• TB contact tracing register
• STI Surveillance Form
• Schistosomiasis investigation Form
• Leptospirosis Investigation Form
• Contact tracing: list and monitoring forms (WHO 2018)
• Event-based surveillance form (PAHO/WHO 2016 in the Caribbean)