Philippine Integrated Disease Republic Act 3573 (Law of Reporting of Communicable

Surveillance and Response Diseases), requires all individuals and health facilities to
report notifiable diseases to local and national public health authorities.

Weekly Notifiable Disease Report

Summary Page

Name of Disease Reporting Unit : ____________________________________________________________

Type of facility:  Gov’t Hospital  Private Hospital  Rural Health Unit  Clinic
 City Health Office  Gov’t Laboratory  Private Laboratory  Seaport/Airport
Address: ____________________________________________________________ Tel. No._____________

This report was prepared by: _____________________________________________ Date: ____/___/_____

(Signature over printed name)
This report was submitted to
(Name of RHU/CHO/PHO/CHD): __________________________________________ Date: ____/____/____

This report was approved by: _____________________________________________ Date: ____/____/____

List of Notifiable Diseases/Syndromes

Indicate the number of case/s in the corresponding line for case/s of disease/
syndrome seen and “0” if no cases seen.

Category I (Immediately Notifiable) Category II (Weekly Notifiable)

_____ Acute Flaccid Paralysis _____ Acute Bloody Diarrhea

_____ Adverse Event Following Immunization (AEFI) _____ Acute Encephalitis Syndrome
_____ Anthrax _____ Acute Hemorrhagic Fever Syndrome
_____ Measles-Rubella _____ Acute Viral Hepatitis
_____ Meningococcal Disease _____ Bacterial Meningitis
_____ Neonatal Tetanus _____ Chikungunya
_____ Paralytic Shellfish Poisoning _____ Cholera
_____ Rabies _____ Dengue
_____ Severe Acute Respiratory Infection (SARI) _____ Diphtheria
_____ Hand, Foot and Mouth Disease _____ Influenza-like Illness
_____ Leptospirosis
_____ Malaria
_____ Non-neonatal Tetanus
_____ Pertussis
_____ Rotavirus
_____ Typhoid and Paratyphoid Fever

Category I: Notify simultaneously the PHO and DOH within 24 hours of detection and send advance copy of the
Case Investigation Form (CIF) as soon as possible.
Category II: Report all cases of notifiable diseases/syndromes every MONDAY of the week to the next higher level
using the Case Report Form (CRF).

Reminder: Submission of report is every MONDAY of the week. The weekly report should include this page (Summary Page) ,
Case Investigation Forms (CIF).

“Let’s help prevent epidemics”