Event-Based Surveillance and Response Verification

Regional Epidemiology and Surveillance Unit
Metro Manila Center for Health Development

Event-based Surveillance and Response (ESR)
Tel: (02)531-0037 loc 116-117
E-mail: resunccr.esrdog@gmail.com

Date of Release

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Document Type: Verification report Follow-up report no: Code:
I. DETECTION
Date detected: Time detected: AM PM Source of information: R/LESU Internet/Media Others
II. FILTER AND VERIFICATION
Date of verification: Time of verification: AM PM Type of health event: Suspect Confirmed Clustering Increasing Outbreak Others If outbreak, was there an official declaration? Yes No N/A If yes, who declare it? LGU CHD-RESU DOH-EB Others For LGU declared outbreak, was it validated by RESU? Yes No N/A Date of declaration:
a. Description of health event
Title of health event Location of health event: Region Province/PHI Municipality Barangay Name of Facility/Others Start Date: Last Onset: Initial/previous reported no. of cases: Added Subtracted Total no. of cases: Initial/previous reported no. of deaths: Added Subtracted Total no. of deaths: b. Health status (indicate counts of case/s) c. Profile of cases (indicate counts of case/s) d. Profile of deaths (indicate counts of death/s) Admitted: RHU/OPD consulted: No consultation: For verification: Sex: Male: Female: Unknown: Age/Age range: Min: Max: Median: Sex: Male: Female: Unknown: Age/Age range: Min: Max: Median:
e. Summary of the health event (Describe what happened, common signs and symptoms, diagnosis, and the timeline of events, and distribution of cases and deaths if multiple locations are affected)

f. outcome (indicate counts of case/s) ActiveRecoveredDiedFor Verification
g. Laboratory details(fill up table below if laboratory examination is done) Was there a procedure done? Yes No N/A
Source (human/animal/ environment/etc.) Type of Specimen Type of Examination done Etiologic agent/pathogen isolated/detected No. of cases/ samples tested No. of positive cases/ samples No. of negative cases/ samples Remarks
III. ASSESSMENT
a. Status of Health Event Open Closed Date Closed:
b. Level of Concern ( Please select criteria based on the assessment )
Public Health Event of Local Concern (PHELC)
The health event is confined in a specific geographical location (barangay/cities/municipalities) The number and severity of cases, deaths, and affected population are higher than expected but within the healthcare system capacity The health event may involve diseases with existing guidelines for the implementation of preventive and/or control measures to manage the event
Public Health Event of Regional Concern (PHERC)
The health event has potential to spread to other provinces/Highly urbanized Cities/Independent Component Cities The number and severity of cases, deaths, and affected population are higher than expected and/or cases are continuously increasing despite response activities conducted The health event requires technical assistance from the regional level in the conduct of epidemiological investigation and/or conduct of control measures
Public Health Event of National Concern (PHENC)
The health event has potential characteristics to cross boundaries or borders (regions or other countries) Novel health event The health event may require national level attention, resources and immediate implementation of control measures due to either of the following: Has attracted public, media or political interest The epidemic transmission route is new or unusual Epidemics associated with health service failure or linked to breakdown in standards of health care delivery such as the following but not limited to infection control failure or systemic immunization failure
Public Health Emergency of International Concern (PHEIC)
Health event formally declared by the World Health Organization (WHO)
c. Assistance needed ( Please specify request)
Category Yes/No Details/Description Remarks 1. Technical support for surveillance Y N 2. Human resource Y N 3. Medicines/Medical supplies Y N 4. Laboratory supplies/logistics Y N 5. Health promotion materials Y N 6. Field/Epidemiologic investigation Y N 7. Others Y N
IV. RESPONSE
Response Office/Agency Specific Actions taken/Planned activities Date started Status (pending/ongoing/done) 1. Case management 2. Laboratory confirmation 3.Field/Epidemiologic investigation* 4. Program management/counter measures 5. Health education and promotion 6. Response coordination mechanism 7. Others *Level of ESU who conducted epidemiologic investigation (select all that applies) MESU CESU PESU RESU EB
V. REPORT GENERATION
Name (s) of source(s) of information Contact number of sources of information Who has been informed? Prepared Reviewed/Noted by: Approved by: Signature Name: Designation/position: Signature Name: Designation/position: Signature Name: Designation/position:
Public Health Event of Local (L), Regional (R), National (N) ConcernPublic Health Emergency of International Concern (PHEIC); according to WHO-International Health Regulation Definition
Disclaimer: Information indicated in this report may change upon further validation or investigation made by the epidemiology and surveillance units and other concerned agencies.

Attach File

Patient ID	Patient Name	Gender	Blood Group	Age

Regional Epidemiology and Surveillance UnitMetro Manila Center for Health Development

Event-based Surveillance and Response (ESR)Tel: (02)531-0037 loc 116-117E-mail: resunccr.esrdog@gmail.com

Regional Epidemiology and Surveillance Unit
Metro Manila Center for Health Development

Event-based Surveillance and Response (ESR)
Tel: (02)531-0037 loc 116-117
E-mail: resunccr.esrdog@gmail.com