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PL Forms PDF

This document contains reporting forms for an IDSP (Integrated Disease Surveillance Program). Form P is a weekly reporting format for healthcare institutions to report the number of cases of various diseases seen. It includes lines to report diseases like acute diarrheal disease, hepatitis, malaria, dengue, encephalitis, measles and more. Form L is a weekly reporting format for laboratories to report the number and results of samples tested for diseases like dengue, chikungunya, meningitis, typhoid, hepatitis and more. It also includes a line list of positive cases with patient details.

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Ravi Parmar
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132 views

PL Forms PDF

This document contains reporting forms for an IDSP (Integrated Disease Surveillance Program). Form P is a weekly reporting format for healthcare institutions to report the number of cases of various diseases seen. It includes lines to report diseases like acute diarrheal disease, hepatitis, malaria, dengue, encephalitis, measles and more. Form L is a weekly reporting format for laboratories to report the number and results of samples tested for diseases like dengue, chikungunya, meningitis, typhoid, hepatitis and more. It also includes a line list of positive cases with patient details.

Uploaded by

Ravi Parmar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM P

(Weekly Reporting Format –IDSP)

Name of Reporting Institution: I.D. No.:


State: District: Block/Town/City:
Officer-in-Charge Name: Signature:
IDSP Reporting Week:- Start Date:- End Date:- Date of
Reporting:-
___/___/______ ___/___/______ ___/___/______

Diseases/Syndromes No. of cases


S.no
1 Acute Diarrhoeal Disease (including acute gastroenteritis)
2 Bacillary Dysentery
3 Viral Hepatitis
4 Enteric Fever
5 Malaria
6 Dengue / DHF / DSS
7 Chikungunya
8 Acute Encephalitis Syndrome
9 Meningitis
10 Measles
11 Diphtheria
12 Pertussis
13 Chicken Pox
14 Fever of Unknown Origin (PUO)
15 Acute Respiratory Infection (ARI) / Influenza Like Illness (ILI)
16 Pneumonia
17 Leptospirosis
18 Acute Flaccid Paralysis
< 15 Years of Age
19 Dog bite
20 Snake bite
21 Any other State Specific Disease
(Specify)
22 Unusual Syndromes NOT Captured Above (Specify clinical
diagnosis)
Total New OPD attendance (Not to be filled up when data
collected for indoor cases)
Action taken in brief if unusual increase noticed in
cases/deaths for any of the above diseases
FORM L
(Weekly Reporting Format – IDSP)

Name of the Laboratory: Institution:


State: District: Block/Town/City:
Officer-in-Charge: Name: Signature:
IDSP Reporting Week:- Start Date:- End Date:- Date of
Reporting:-
___/___/______ ___/___/______ ___/___/______

Diseases No. Samples Tested No. found Positive


Dengue / DHF / DSS
Chikungunya
JE
Meningococcal Meningitis
Typhoid Fever
Diphtheria
Cholera
Shigella Dysentery
Viral Hepatitis A
Viral Hepatitis E
Leptospirosis
Malaria PV: PF:
Other (Specify)
Other (Specify)

Line List of Positive Cases (Except Malaria cases):


Name Age Sex Address: Name of Test Diagnosis (Lab
(Yrs) (M/F) Village/Town Done confirmed)

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