Questionnaires for Clinical Surveillance

All paediatricians notifying a case of AFP are requested by the AFP co-ordinator to complete a clinical surveillance questionnaire. This initial questionnaire is sent at the time of notification.

The questionnaire and laboratory test results are then reviewed by the Polio Expert Panel. In the event that the committee is unable to classify the case, a follow-up questionnaire is issued to request further information on the case.

For more information please contact the AFP Surveillance co-ordinator at polio@mh.org.au or 03 9342 2607.

 

Initial Questionnaire

   

for printed submissions

 

for electronic submissions

 

Follow up Questionnaire

     

for printed submissions

for electronic submissions

please send all electronic questionnaires to the AFP Surveillance co-ordinator at polio@mh.org.au