KENYA CASE INVESTIGATION FORM

MINISTRY OF HEALTH

Division of Disease Surveillance and Surveillance

Case investigation form for 2019 Novel Coronavirus (COVID-19)

Section 1: Patient information (All fields in this section must be filled in)

1.6 Age




1.8.1 If health facility, name of health facility: GERTRUDE’S CHILDREN’S HOSPITAL

Contact Person: Dr. THOMAS NGWIRI 0733 753 650 Email:TNGWIRI@GERTIES.ORG

Email results to:Dr. BEATRICE KABERA 0721 203 153 Email: BKABERA@GERTIES.ORG

Section 2: Clinical information

Patient clinical course

Patient signs


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