| CBHI form No. | 01 | ||||||||||||||
| Weekly | |||||||||||||||
| WEEKLY EPIDEMIOLOGICAL REPORT ON CHOLERA(A00) / PLAGUE( A20) IN STATE/UT | |||||||||||||||
| NAME OF STATE / UT | |||||||||||||||
| WEEKLY EPIDEMIOLOGICAL REPORT FOR THE WEEK ENDING (date) | Week No. | YEAR | |||||||||||||
| (A) WEEKLY REPORT ON CHOLERA (A00) | |||||||||||||||
| Sl. No. | Name of DISTRICT /CITY reported the case | NUMBER DURING THE REPORTING WEEK | CUMULATIVE TOTAL (Till this reporting Week) | Whether Area notified as Cholera infected (yes/no) if Yes Give details of Area | |||||||||||
| Cases | Deaths | Cases | Deaths | ||||||||||||
| M | F | T | M | F | T | M | F | T | M | F | T | ||||
| M - Male; F - Female; T - Total | |||||||||||||||
| A.1 DELAYED AND/OR CORRECTED REPORT ON INCIDENCE OF CHOLERA (AOO) | |||||||||||||||
| Sl. No. | Name of DISTRICT/CITY reported the case | Week No. | Week ending date | No. of Cases / Deaths | Whether Area notified as Cholera infected (yes/no) if Yes Give details of Area | ||||||||||
| Cases | Deaths | ||||||||||||||
| M | F | T | M | F | T | ||||||||||
| ICD 10 codes in Parenthesis | |||||||||||||||
| Note : This weekly report for the week "Sunday through Saturday (7 days)" should be dispatched on the reporting week ending | |||||||||||||||
| Saturday itself to CBHI, New Delhi through E-mail "dircbhi@nb.nic.in" | Contd..2 | ||||||||||||||
| -2 - | |||||||||||||||
| (B) WEEKLY REPORT ON PLAGUE (A20) | |||||||||||||||
| Sl. No. | Name of DISTRICT /CITY reported the case | NUMBER DURING THE REPORTING WEEK | CUMULATIVE TOTAL (Till this reporting Week) | Whether Area notified as Cholera infected (yes/no) if Yes Give details of Area | |||||||||||
| Cases | Deaths | Cases | Deaths | ||||||||||||
| M | F | T | M | F | T | M | F | T | M | F | T | ||||
| B.1 DELAYED AND/OR CORRECTED REPORT ON INCIDENCE OF PLAGUE (A2O) | |||||||||||||||
| Sl. No. | Name of DISTRICT/CITY reported the case | Week No. | Week ending date | No. of Cases / Deaths | Whether Area notified as Cholera infected (yes/no) if Yes Give details of Area | ||||||||||
| Cases | Deaths | ||||||||||||||
| M | F | T | M | F | T | ||||||||||
| ICD 10 codes in Parenthesis | |||||||||||||||
| C.AREA(S) NOTIFIED AS CHOLERA / PLAGUE INFECTED EARLIER BUT DECLARED CHOLERA / PLAGUE FREE DURING THIS REPORTING WEEK | |||||||||||||||
| NAME OF DISTRICT /TALUKA/CITY/ TOWN/VILLAGE DECLARED FREE | |||||||||||||||
| Cholera | |||||||||||||||
| Plague | |||||||||||||||
| Note : This weekly report for the week "Sunday through Saturday (7 days)" should be dispatched on the reporting week ending | |||||||||||||||
| Saturday itself to CBHI, New Delhi through E-mail "dircbhi@nb.nic.in" | |||||||||||||||
| To | |||||||||||||||
| The
Director Central Bureau of Health Intelligence (CBHI) Room No. 401 - A Wing, Nirman Bhavan New Delhi – 110011 E-Mail: dircbhi@nb.nic.in Tel/ Fax: 91-011-23793175 / 23017695 |
Signature | ||||||||||||||
| Name & Designation | |||||||||||||||
| Address with | |||||||||||||||
| Tele/ Fax & E-Mail | |||||||||||||||