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CBHI Form
No. |
02 |
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Monthly |
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| MONTHLY
REPORT ON INSTITUTIONAL CASES AND DEATHS DUE TO |
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PRINCIPAL COMMUNICABLE DISEASES IN THE
STATE/UT |
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NAME OF THE STATE/UT |
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REPORTING MONTH & YEAR |
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Total No. of Medical |
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Total No. of Medical Care Institution reported during the
month |
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Care Institutions in the State/UT$ |
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| Sl. No. |
Name of
Disease as per standard |
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Patients Treated |
Deaths |
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| definition of
case |
ICD - 10 |
OPD* |
IPD* |
Total |
(IPD Only) |
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code |
M |
F |
M |
F |
M |
F |
M |
F |
T |
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| 1 |
Acute Diarrhoeal
Diseases** |
A09 |
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(including Gastro Enteritis Etc.) |
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| 2 |
Diphtheria |
A36 |
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| 3 |
Acute Poliomyelitis (New
listed cases) |
A80 |
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| 4 |
Tetanus other than
Neonatal |
A35 |
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| 5 |
NeoNatal Tetanus |
A33 |
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| 6 |
Whooping Cough |
A37 |
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| 7 |
Measels |
B05 |
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| 8 |
Acute Respiratory Infection |
J22 |
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(including Influenza and excluding Pneumonia) |
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| 9 |
Pneumonia |
J18 |
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| 10 |
Enteric Fever |
A01 |
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| 11 |
Viral Hepatitis - A |
B15.9 |
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| 12 |
Viral Hepatitis - B |
B16.9 |
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| 13 |
Viral Hepatitis - C,D,
E |
B17.8 |
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| 14 |
Meningococcal
Meningitis |
A39.0 |
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| 15 |
Rabies *** |
A82 |
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| 16 |
AIDS (as reported to
NACO) |
B24 |
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| 17 |
Syphilis |
A50-A53 |
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| 18 |
Gonococcal
Infection |
A54 |
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| 19 |
Other STD Diseases |
A63-A64 |
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| 20 |
Pulmonary
Tuberculosis |
A16.2 |
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TOTAL |
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*IPD-In-Patient
OPD-Out-Patient |
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M-Male, F - Female, T-Total |
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| The report
for every month should be dispatched to CBHI by 20th of the succeeding
month through e-mail dircbhi@nb.nic.in |
| NOTES: |
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| $ |
All the medical institutions i.e. Hospitals,
Dispensaries, Clinics, PHCs, CHCs, Sanatoria etc. to be covered |
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The cases and deaths due to various diseases other than those
treated in Medical Institutions, whenever reported / recorded should also
be included in this report |
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| ** |
Acute
diarrhoeal disease should include all Gastro Enteritis cases i.e. cases
with three or more loose watery |
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motions in a day, irrespective of aetiology
/ causation |
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| *** |
Only confirmed cases of Rabies i.e.
Hydrophobia should be included and not the simple dog-bite/animal bite
cases |
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Data on vaccine preventable disease
should tally with Universal Immunization Program (UIP) data being
furnished by |
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State EPI (Extended Program of Immunisation)
officer to Min. of Health & FW |
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| ********** |
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To |
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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
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Signature |
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Name
& Designation |
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Address with Tel/Fax & E-Mail |
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