Food History Optional for sporadic cases Please try to remember what you ate in the last 3-7 days before you started feeling sick. We’ll start with the day you got sick and work backwards. If a meal was eaten out, specify where you ate and what was eaten, including garnishes and beverages. Day Meal AM/ PM Place Food Consumed (Include name, address, city/town) Breakfast AM PM Day 3 (3 days AM PM of onset) Dinner AM PM Snack AM PM Day 4 Breakfast AM PM (4 days Lunch AM PM before onset) Dinner AM PM Snack AM PM Day 5 Breakfast AM PM (5 days Lunch AM PM before onset) Dinner AM PM Snack AM PM
Food History Optional for sporadic cases Please try to remember what you ate in the last 3-7 days before you started feeling sick. We’ll start with the day you got sick and work backwards. If a meal was eaten out, specify where you ate and what was eaten, including garnishes and beverages. Day Meal AM/ PM Place (Include name, address, city/town) Food Consumed Day 3 (3 days of onset) Breakfast AM PM AM PM Dinner AM PM Snack AM PM Day 4 (4 days before onset) Breakfast AM PM Lunch AM PM Dinner AM PM Snack AM PM Day 5 (5 days before onset) Breakfast AM PM Lunch AM PM Dinner AM PM Snack AM PM
Yersiniosis%20Investigation%20Tool.docx