Record of File ♦ ♦ Date Investigator’s Investigator’s Designation Responsible Investigator’s Signature Initials 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 Call 2 Outgoing Incoming Call 3 Outgoing Incoming Call 4 Outgoing Incoming Outgoing Call 5 Incoming Call 6 Outgoing Incoming Date letter sent: Case Details ♦ Giardia lamblia/ intestinalis/ duodenalis Aetiologic Agent Subtype Further Differentiation ♦ ♦ Classification Confirmed Probable Does Not Meet Definition Classification Date ♦ ♦ Outbreak Case Outbreak Confirmed Probable Does Not Meet Definition Classification Classification Date Complete Closed- Duplicate-Do Not Use ♦ ♦ Disposition Entered In Error Lost to Follow Up Disposition Date Does Not Meet Definition Untraceable ♦ Closed Status Date ♦ ♦ Status Open (re-opened) Status Date ♦ 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 Initials 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 Call 6 Outgoing Incoming Date letter sent: Case Details ♦ Aetiologic Agent Giardia lamblia/ intestinalis/ duodenalis Subtype Further Differentiation ♦ Classification Confirmed Probable Does Not Meet Definition ♦ Classification Date ♦ Outbreak Case Classification Confirmed Probable Does Not Meet Definition ♦ 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)
Giardiasis%20Investigation%20Tool.docx