Postville CSD School Board Policies

The policies on this site are deemed reliable but are not guaranteed accurate. Please check and confirm with the superintendent secretary for official policies.

Code No. 507.3E3 Reporting Form

Student Personnel

Series 500

Code No. 507.3E3

Policy Title:  Reporting Form

 

Source:  Iowa Department of Public Health (1997).

REPORT THE FOLLOWING DISEASES IMMEDIATELY BY TELEPHONE (1-800-362-2736)

Botulism Poliomyelitis Yellow Fever
Cholera Rabies (Human) Disease outbreaks of
Diphtheria Rubella       any public health concern
Plague Rubeola (measles)  
REPORT ALL OTHER DISEASES BELOW. WEEK ENDING  
See other side for list of reportable infectious diseases.
DISEASE PATIENT COUNTY OR CITY DOB SEX
  Name                                                              Parent (If applicable)      
Address
Attending Physician

 

Reporting Physician, Hospital, or Other Authorized Person

Address
Remarks:

 

FOR SCHOOLS ONLY:  Report over 10% absent only.  Total enrollment:                                               
Monday Tuesday Wednesday Thursday Friday
No.

Absent

         
% of Enrollment          
REPORT NUMBER OF CASES ONLY

                Chickenpox                                                                                             Gastroenteritis

                Erythema infectiosum (5th Disease                                                          Influenza-like illness (URI)


Approved:  3-8-04                               Reviewed:    2-11-13           Revised: ______________

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