Record of File ♦ ♦ Date Investigator’s Investigator’s Designation Responsible Investigator’s Signature Signature Health Unit Name Investigation Start Date PHI PHN Other Assignment Date PHI PHN Other Call Log Details Date Start Time Type of Call Call To/From Outcome Investigator’s (contact made, v/m, text, initials email, no answer, etc.) Call 1 Outgoing Incoming Outgoing Call 2 Incoming Call 3 Outgoing Incoming Call 4 Outgoing Incoming Call 5 Outgoing Incoming Date letter sent: Case Details ♦ Aetiologic Agent Borrelia burgdorferi Borrelia afezelii Borrelia garinii ♦ Classification Confirmed Person Under Investigation ♦ Classification Date Probable Does Not Meet Definition Do not close case as PUI ♦ Confirmed Person Under Investigation Outbreak Case ♦ Outbreak Classification Probable Does Not Meet Definition Classification Date Do not close case as PUI ♦ ♦ Disposition Complete Closed- Duplicate-Do Not Use Disposition Date Entered In Error Lost to Follow Up Does Not Meet Definition Untraceable ♦ Closed Status Date ♦ Open (re-opened) ♦ Status Date Status ♦ Closed Status Date ♦ Priority High Medium Low (At health unit’s discretion)
Record of File ♦ Responsible Health Unit Date ♦ Investigator’s Name Investigator’s Signature Investigator’s Signature Designation Investigation Start Date PHI PHN Other Assignment Date PHI PHN Other Call Log Details Date Start Time Type of Call Call To/From Outcome (contact made, v/m, text, email, no answer, etc.) Investigator’s initials Call 1 Outgoing Incoming Call 2 Outgoing Incoming Call 3 Outgoing Incoming Call 4 Outgoing Incoming Call 5 Outgoing Incoming Date letter sent: Case Details ♦ Aetiologic Agent Borrelia burgdorferi Borrelia afezelii Borrelia garinii ♦ Classification Confirmed Person Under Investigation Probable Does Not Meet Definition Do not close case as PUI ♦ Classification Date ♦ Outbreak Case Classification Confirmed Person Under Investigation Probable Does Not Meet Definition Do not close case as PUI ♦ Outbreak Classification Date ♦ Disposition Complete Closed- Duplicate-Do Not Use Entered In Error Lost to Follow Up Does Not Meet Definition Untraceable ♦ Disposition Date ♦ Status Closed ♦ Status Date Open (re-opened) ♦ Status Date Closed ♦ Status Date ♦ Priority High Medium Low (At health unit’s discretion)