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2 Indian Guidelines DENGUE
2 Indian Guidelines DENGUE
2 Indian Guidelines DENGUE
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Annexure IV
LAB REQUISITION FORM
State / District.......... Regn. No. ....
PHC/Name of Institute ......
Name of the patient Age/Sex.
Date of admission
Addresss ..
Local ..
Permanent ...
Telephone No.
Clinical findings
Fever Duration Days ..
Any other finding ..
Date of collection of sample ...
Nature of Sample
Tick the box
Serum Whole Blood
Name and Signature of MO..
Results
Patient ID..
Patient of Name..
Date of collection..Date of reporting..
Tick the box
Test type Positive Negative
IgM Mac ELISA
IgG Paired Sera
RDT
Name and signature of the Investigator
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References (for further information)
(1) Suchitra Nimmannitya: Clinical Manifestations of DF/DHF - WHO Regional
Publication No. 22, Monograph on Dengue/DHF, pp 48-54, WHO/SEARO,
New Delhi.
(2) Suchitra Nimmannitya: Management of DF/DHF- WHO Regional Publication
No. 22 Monograph on Dengue/DHF-pp 55-61, WHO/SEARO, New Delhi.
(3) Suchitra Nimmannitya: Dengue Haemorrhagic Fever: diagnosis and
management, pp 133-145, in Dengue and Dengue Haemorrhagic Fever edited
by D.J. Gubler and G. Kuno, Published by CAB international, 1997.
(4) Dengue Haemorrhagic Fever diagnosis, treatment, prevention and control,
2nd Edition, WHO Geneva, 1997.
(5) Prevention and Control of Dengue and Dengue Haemorrhagic Fever
Comprehensive Guidelines WHO Regional Publications SEARO No. 29, New
Delhi, 1999 .
(6) Long Term Action Plan for prevention and control of Dengue and Chikungunya
: Directorate of National Vector Borne Disease Control Programme, ( Dte.
General of Health Services), Ministry of Health and Family Welfare, Govt of
India, 2007.
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