Hawaii eCR Reporting Volume

Please complete this survey to indicate the volume of case reporting for infectious diseases in 2018.

If you have any questions, please contact DOH.ELR.Hawaii@doh.hawaii.gov

Thank you!

Question Title

* 1. Provider Name (as listed on the registration)

First Name

Last Name

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* 2. Name, Email, and Phone # of person completing this form

First Name

Last Name

Email Address

Phone Number

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* 3. Does your practice diagnose any of the following bacterial pathogens of systemic diseases (check all that apply)?

Campylobacter

Enterotoxigenic E. coli

Listeria monocytogenes

Salmonella

Salmonella typhi

Shiga toxin producing E. coli

Shigella

Vibrio

Yersinia

All of the Above

None of the Above

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* 4. Does your practice diagnose any of the following parasites causing enteric illness (check all that apply)?

Cryptosporidium spp

Cyclospora cayetanensis

Trichinella

All of the Above

None of the Above

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* 5. Does your practice diagnose any of the following viruses causing vaccine preventable diseases (check all that apply)?

Measles

Mumps

Bordetella pertussis

Varicella-zoster virus

All of the Above

None of the Above

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* 6. Does your practice diagnose any of the following bacterial pathogens of pneumonia and meningitis (check all that apply)?

Haemophilus influenzae

Neisseria meningitidis

Streptococcus pneumonia

Listeria monocytogenes

All of the Above

None of the Above

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* 7. Does your practice diagnose any of the following viruses that cause arboviral diseases (check all that apply)?

Chikungunya

Dengue

Eastern Equine Encephalitis

Saint Louis Encephalitis

Western Equine Encephalitis

West Nile

All of the Above

None of the Above

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* 8. Does your practice diagnose any of the following viruses that screen for Hepatitis disease (check all that apply)?

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis D

All of the Above

None of the Above

Disease Reporting Volume in 2018. For each category of diseases below (#9-13), please select the number of cases that you would have diagnosed and reported in 2018.

Hawaii eCR Reporting Volume

Question Title

* 1. Provider Name (as listed on the registration)

Question Title

* 2. Name, Email, and Phone # of person completing this form

Question Title

* 3. Does your practice diagnose any of the following bacterial pathogens of systemic diseases (check all that apply)?

Question Title

* 4. Does your practice diagnose any of the following parasites causing enteric illness (check all that apply)?

Question Title

* 5. Does your practice diagnose any of the following viruses causing vaccine preventable diseases (check all that apply)?

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* 6. Does your practice diagnose any of the following bacterial pathogens of pneumonia and meningitis (check all that apply)?

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* 7. Does your practice diagnose any of the following viruses that cause arboviral diseases (check all that apply)?

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* 8. Does your practice diagnose any of the following viruses that screen for Hepatitis disease (check all that apply)?

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* 9. Enterics (Salmonella, E. Coli, Listeria, Hepatitis A...)

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* 10. Vaccine Preventable Diseases

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* 11. Sexually Transmitted Diseases

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* 12. Hepatitis C

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* 13. Zoonotic Diseases (Zika, Malaria...)