Philippine Integrated Disease Republic Act 3573 (Law of Reporting of Communicable

Surveillance and Response Diseases), requires all individuals and health facilities to
report notifiable diseases to local and national public health authorities.

Weekly Notifiable Disease Report

Summary Page

Name of Disease Reporting Unit : _________________________________________________________________

Type of facility:  Gov’t Hospital  Private Hospital  Rural Health Unit  Clinic
 City Health Office  Gov’t Laboratory  Private Laboratory  Seaport/Airport
Address: ____________________________________________________________ Tel. No.______________

This report was prepared by: _____________________________________________ Date: ____/____/____

(Signature over printed name)
This report was submitted to
(Name of RHU/CHO/PHO/CHD): __________________________________________ Date: ____/____/____

This report was approved by: ______________________________________________Date: ____/____/____

List of Notifiable Diseases/Syndromes

Indicate the number of case/s in the corresponding line for case/s of disease/
syndrome seen and “0” if no cases seen.

Category I (Immediately Notifiable) Category II (Weekly Notifiable)

_____ Acute Flaccid Paralysis _____ Acute Bloody Diarrhea

_____ Adverse Event Following Immunization (AEFI) _____ Acute Meningitis Encephalitis Syndrome
_____ Anthrax _____ Acute Encephalitis Syndrome
_____ Ebola Virus Disease _____ Acute Hemorrhagic Fever Syndrome
_____ Hand, Foot and Mouth Disease _____ Acute Viral Hepatitis
_____ Malaria _____ Bacterial Meningitis
_____ Measles-Rubella _____ Chikungunya
_____ Meningococcal Disease _____ Cholera
_____ MERS– CoV _____ Dengue
_____ Neonatal Tetanus _____ Diphtheria
_____ Paralytic Shellfish Poisoning _____ Influenza-like Illness
_____ Rabies _____ Leptospirosis
_____ Severe Acute Respiratory Infection (SARI) _____ Non-neonatal Tetanus
_____ Zika Virus Disease _____ Pertussis
_____ Outbreaks _____ Rotavirus
 Clusters of diseases _____ Typhoid and Paratyphoid Fever
 Unusual diseases or threats

Category I: Notify simultaneously the PHO and DOH within 24 hours of detection and send advance
copy of the Case Investigation Form (CIF) as soon as possible.
Category II: Report all cases of notifiable diseases/syndromes every FRIDAY of the week to the next higher
level using the Case Report Form (CRF).

Reminder: Submission of report is every FRIDAY of the week. The weekly report should include this page (Summary Page) ,
Case Investigation Forms (CI
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