Daily Case Reporting Performa Dengue Fever

Cheema Heart Complex & General Hospital Gujranwala.

Tel # 055-3255959, 3731559, Mob # 0300-9649291
A:
S#

Name of
Patient

Father/
Husband
Name

Age Sex

Labs

Complete Residential Address

Contact #

TLC

Name Of
Date
Signs & hospital for Date o f
of
Symptoms isolation/ Admission
Platelet Serology
Discharge
Quarantine

Out Come
(Recovered/
died or
Discharged)

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

B.

Cumulative cases reported

Suspected Admissions/Referrals

Deaths
Still Admitted

Previous

In last 24 Hrs

Cumulative

Nil

Nil

Nil

Nil

Discharged

Laboratory Diagnosed Positive Cases

Previous

Last
24 Hrs

Cumulative

Previous

Nil

Nil

Nil

Nil

Nil

Reported by

Last

24
Hrs

Nil

Dr. Adeel Iftikhar Ahmad

Countersigned by
Dated
Contact No.

Cumulative

September 23, 2016

0301-6628280

Nil