Flu Hospitalizations and Death Reporting 2013-2014

Flu Hospitalizations and Death Reporting

 
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1. Hospital Name (select from drop-down menu):
2. Phone:
3. Email:
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4. Please select the week for which you are reporting (see reporting calendar below):
Week 40: 9/29/2013 - 10/5/2013
Week 41: 10/6/2013 - 10/12/2013
Week 42: 10/13/2013 - 10/19/2013
Week 43: 10/20/2013 - 10/26/2013
Week 44: 10/27/2013 - 11/2/2013
Week 45: 11/3/2013 - 11/9/2013
Week 46: 11/10/2013 - 11/16/2013
Week 47: 11/17/2013 - 11/23/2013
Week 48: 11/24/2013 - 11/30/2013
Week 49: 12/1/2013 - 12/7/2013
Week 50: 12/8/2013 - 12/14/2013
Week 51: 12/15/2013 -12/21/2013
Week 52: 12/22/2013 - 12/28/2013
Week 1: 12/29/2013 - 1/4/2014
Week 2: 1/5/2014 - 1/11/2014
Week 3: 1/12/2014 - 1/18/2014
Week 4: 1/19/2014 - 1/25/2014
Week 5: 1/26/2014 - 2/1/2014
Week 6: 2/2/2014 - 2/8/2014
Week 7: 2/9/2014 - 2/15/2014
Week 8: 2/16/2014 - 2/22/2014
Week 9: 2/23/2014 - 3/1/2014
Week 10: 3/2/2014 - 3/8/2014
Week 11: 3/9/2014 - 3/15/2015
Week 12: 3/16/2014 - 3/22/2014
Week 13: 3/23/2014 - 3/29/2014
Week 14: 3/30/2014 - 4/5/2014
Week 15: 4/6/2014 - 4/12/2014
Week 16: 4/13/2014 - 4/19/2014
Week 17: 4/20/2014 - 4/26/2014
Week 18: 4/27/2014 - 5/3/2014
Week 19: 5/4/2014 - 5/10/2014
Week 20: 5/11/2014 - 5/17/2014
INSTRUCTIONS: Enter below the number of hospitalized patients with a recent positive influenza laboratory test (including PCR, rapid influenza test, DFA, IFA or culture) in your institution within each age group. Please report only patients whose specimens were taken during the week for which you are reporting (for example, if the patient was hospitalized in week A, but did not have a specimen taken until week B, please report the patient as an influenza hospitalization for week B). Please report ALL types and subtypes of influenza.
5. Please enter the number of hospitalized patients with positve influenza laboratory tests* in your institution in the past week (Sunday-Saturday):

*Influenza disease confirmed by PCR, rapid influenza test, DFA, IFA or culture.
INSTRUCTIONS: Enter below the number of new deaths in patients with laboratory-confirmed influenza (including PCR, rapid influenza test, DFA, IFA or culture) that occured in your institution within each age group (regardless of whether a patient was admitted). Please report only deaths that occurred in your institution during the week for which you are reporting. This should include ALL types and subtypes of infleunza.
6. Please enter the number of new deaths in patients with laboratory-confirmed influenza* in your institution in the past week (Sunday-Saturday):

*Influenza disease confirmed by PCR, rapid influenza test, DFA, IFA or culture.
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