Polio Eradication Toolkit

CBS Initial Reporting Form for Suspected AFP Cases

Length: 1 page (A4)
Year: 2016
Organization: CGPP South Sudan
Country: South Sudan
Language: English

This form is used by County Supervisors to provide information about suspected AFP cases that have been reported by key informants and verified to be true AFP cases. The information on this form is then transferred to the AFP line list that is sent at the end of each month to the partner’s head office. The IRF contains information on the reported AFP cases, demographic information, dates of reporting, verification visits by payam assistants, county supervisors, outcome of the reported cases (old or new), date reported to WHO field staff for validation, EPID number and signature to confirm that the case has been validated.