A-5: CBS Line-list of Suspect AFP Cases State: County: Payam: Section B Section C Section D KI WHO CS by (Yes/No) Juba paralysis to to PA CS (Recent/Old) (Source) of (WHO/CBS) WHO of of Validation CS by? of AFP) Case by to reached onset visit visit reporting referral referral of of of of of of of (months) Informant Outcome Name Date Date Date Date Date Decision Date Age Village Validated Boma Payam County Key Referred Serial State EPID Samples (AFP/not (Yes/No)? 1 2 3 4 5 6
A-5: CBS Line-list of Suspect AFP Cases State: County: Payam: Section B Section C Section D Serial Name of Case Age (months) Village Boma Payam County State Key Informant (Source) Date of onset of paralysis Date of reporting by KI Date of visit of PA Date of referral to CS Date of visit of CS Decision by CS (Recent/Old) Referred to WHO (Yes/No) Date of referral to WHO Validated by? (WHO/CBS) Outcome of Validation (AFP/not AFP) EPID Samples reached Juba (Yes/No)? 1 2 3 4 5 6