Philippine Integrated Disease Republic Act 3573 (Law of Reporting of Communicable
Surveillance and Response Diseases), requires all individuals and health facilities to
report notifiable diseases to local and national public health authorities.
Weekly Notifiable Disease Report
Summary Page
Name of Disease Reporting Unit : _________________________________________________________________
Type of facility: Gov’t Hospital Private Hospital Rural Health Unit Clinic
City Health Office Gov’t Laboratory Private Laboratory Seaport/Airport
Address: ____________________________________________________________ Tel. No.______________
This report was prepared by: _____________________________________________ Date: ____/____/____
(Signature over printed name)
This report was submitted to
(Name of RHU/CHO/PHO/CHD): __________________________________________ Date: ____/____/____
This report was approved by: ______________________________________________Date: ____/____/____
List of Notifiable Diseases/Syndromes
Indicate the number of case/s in the corresponding line for case/s of disease/
syndrome seen and “0” if no cases seen.
Category I (Immediately Notifiable) Category II (Weekly Notifiable)
_____ Acute Flaccid Paralysis _____ Acute Bloody Diarrhea
_____ Adverse Event Following Immunization (AEFI) _____ Acute Meningitis Encephalitis Syndrome
_____ Anthrax _____ Acute Encephalitis Syndrome
_____ Ebola Virus Disease _____ Acute Hemorrhagic Fever Syndrome
_____ Hand, Foot and Mouth Disease _____ Acute Viral Hepatitis
_____ Malaria _____ Bacterial Meningitis
_____ Measles-Rubella _____ Chikungunya
_____ Meningococcal Disease _____ Cholera
_____ MERS– CoV _____ Dengue
_____ Neonatal Tetanus _____ Diphtheria
_____ Paralytic Shellfish Poisoning _____ Influenza-like Illness
_____ Rabies _____ Leptospirosis
_____ Severe Acute Respiratory Infection (SARI) _____ Non-neonatal Tetanus
_____ Zika Virus Disease _____ Pertussis
_____ Outbreaks _____ Rotavirus
Clusters of diseases _____ Typhoid and Paratyphoid Fever
Unusual diseases or threats
Category I: Notify simultaneously the PHO and DOH within 24 hours of detection and send advance
copy of the Case Investigation Form (CIF) as soon as possible.
Category II: Report all cases of notifiable diseases/syndromes every FRIDAY of the week to the next higher
level using the Case Report Form (CRF).
Reminder: Submission of report is every FRIDAY of the week. The weekly report should include this page (Summary Page) ,
Case Investigation Forms (CI
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