Ebola virus disease case report form
To be able to fill and save the PDF form, you must first download it to your computer and open it with a PDF reader (such as Adobe Reader).
Download the Ebola virus disease case report form (PDF, 70 KB, 5 pages)
How to download and open the PDF
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Instructions for PC users
- Right-click the link of the PDF form you wish to download.
- Select Save link as or Save target as.
- Choose the location on your computer where you want to save the PDF form.
- Go to the file location where you saved the PDF form.
- Open the PDF form with a PDF reader (such as Adobe Reader).
- Fill and save your PDF form.
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Instructions for Mac users
- Press the Control key (Ctrl) and click on the link of the form you wish to download.
- Choose Save link as or Download linked file as.
- Choose the location on your computer where you want to save the PDF form.
- Go to the file location where you saved the PDF form.
- Open the PDF form with a PDF reader (such as Adobe Reader).
- Fill and save your PDF form.
Instructions for completion
- Please complete as much detail as possible on this form at the time of the initial report.
- It is not expected that all fields will be completed during the initial report, but that updates will be made when information becomes available.
Instructions to local public health authorities
- Reporting: Persons under investigation, and confirmed cases of EVD should be reported immediately as per jurisdictional protocols in the respective province or territory in Canada.
Instructions to provincial / territorial public health authorities
- Reporting: Persons under investigation, and confirmed cases of EVD should be reported immediately to the Agency’s Health Portfolio Operations Centre (HPOC) at 1-800-545-7661.
- Requests from provinces and territories for diagnostic or confirmatory laboratory services for EVD should be directed to the Public Health Agency of Canada's National Microbiology Laboratory at 1-866-262-8433.
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