Case Report Form for 2019 Novel Coronavirus | NLM

Disaster Information Management Research Center | NLM

Case Report Form for 2019 Novel Coronavirus

02/06/2020 12:00 AM EST

Source: Centers for Disease Control and Prevention, Office of Infectious Diseases (CDC OID). Published: 2/6/2020. This eight-page Case Report Form is intended for local and state health departments who have a laboratory confirmed case of 2019 novel coronavirus (COVID-19) to report to the Centers for Disease Control and Prevention. The form provides a standardized approach to collecting data in order to track the outbreak, better characterize cases, and inform the public health response. (PDF)