Sample Case Log to Track Residents with Gastrointestinal Illness Individual Identification Location Illness Description Laboratory Confirmation Illness Complications (Y/N) yes, illness Positive Y/N) Unit if (Y/N) (Y/N) and/or ( (Y/N) #, Sample (Y/N) Collected onset designation (Y/N, illness (M/F) Name Age Building, Room Bed Date Nausea Diarrhea Date Collected Date Norovirus Hospitalized Died Sex Vomiting Stool Fever date) resolved (Y/N)
Sample Case Log to Track Residents with Gastrointestinal Illness Individual Identification Location Illness Description Laboratory Confirmation Illness Complications Name Age Sex (M/F) Building, Unit Room #, and/or Bed designation Date onset illness Fever (Y/N) Nausea (Y/N) Vomiting (Y/N) Diarrhea ( Y/N) Date illness resolved Stool Sample Collected (Y/N) Date Collected Norovirus Positive (Y/N) Hospitalized (Y/N) Died (Y/N, if yes, date)