填表说明：1）因呼吸道感染住院病例入院后24小时内登记人应将病例基本信息填入登记表内。病例出院或死亡后24小时内将信息补充完整。
2）“是否采样”及“病人转归”栏内可用打勾进行选择，其余空格需填写详细信息。
附表8
年 月上海市 （区/县） （单位）
流感样病例集聚性发病调查一览表
编号
| 姓名
| 性别
| 年龄
| 班级/科室
| 发病日期
| 是否就诊
| 就诊日期
| 临床诊断
| 转归情况
| 流感疫苗接种史
| 接触史
| 流感样症状
| WBC
| 联系电话
| 备注
|
禽类
| 流感样病例
| 体温（≥38℃）
| 咳嗽
| 咽痛
| 头痛
| 全身酸痛
| 乏力
| 流涕
| 其他
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