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Get HHS CDC 52.5 (E) 2009

Phoid or paratyphoid fever. – Form Approved OMB No. 0920-0009 DEMOGRAPHIC DATA 1. Reporting 2. First three letters of State: 3. Date patient’s last name: or Age: (in years) of birth: Mo. 4. Sex: Male 5. Does the patient work as a foodhandler? pFemale Yes No Day Yr. 6. Citizenship: (21) pU.S. Unk. pUnk. Other: __________________________________________ CLINICAL DATA 7. Was the patient ill with typhoid or paratyphoidfever? (fever, abdominal pain, headache, etc) Yes No I.

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