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Sample Info Matrix

This document appears to be a contact tracing form used to track an individual who has been diagnosed with an illness. It collects information such as the person's name, dates of diagnosis, hospitalization, quarantine, their movements including transportation used, locations visited, degree of contact with others, and address/contact information to contain the spread of the illness.

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Jam Jam
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© © All Rights Reserved
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Download as DOCX, PDF, TXT or read online on Scribd
13 views

Sample Info Matrix

This document appears to be a contact tracing form used to track an individual who has been diagnosed with an illness. It collects information such as the person's name, dates of diagnosis, hospitalization, quarantine, their movements including transportation used, locations visited, degree of contact with others, and address/contact information to contain the spread of the illness.

Uploaded by

Jam Jam
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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NAME:

DATE DIAGNOSED (W/SYMPTOMPS):


DATE ADMITTED IN HOSPITAL:
DATE QUARANTINED:

PERSON
MODE OF PLACES OF DEGREE OF CONTACT ADDRESS/CONTAC
DATE TIME INTERACTED REMARKS
TRANPORTATION ENGAGEMENT (HIGH/MODERATE/LOW) T NOS.
WITH

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