FOR MORE INFO, VISIThttps://www.resu.
online
Republic of the Philippines
DOH Regional Office for MIMAROPA EVENT-BASED SURVEILLANCE & RESPONSE
REGIONAL EPIDEMIOLOGY & SURVEILLANCE UNIT
FILL-IN WHATEVER INFORMATION IS AVAILABLE,
NO NEED TO COMPLETE, SUBMIT IMMEDIATELY.
Tel: (02) 912-0195 loc. 436Fax: (02) 911-5025
E-mail: resu.4b@gmail.com
Website: https://www.resu.online Available Data as of: 16-Jan-23
Classified Document:
This document is distributed to limited and selected DOH, LGU and NGO staff to improve common awareness on reports and rumors of events
which may have regional/national/international implications. Please observe responsible information sharing as required.
NTO HEALTH EVENT LOCATORNTO PALAWAN YYYY 05 001 Draft (advance copy)
* Primary Source of Info Source Details…
** Prepared by Name Designation Office Contact Info
*** Reviewed/Cleared by Name Designation Office Contact Info
1 Date 1st Notified (capture) Petsa unang nabalitaan ang health event
2 Date Verified Petsa kung kailan umpisang nag verify
3 Health Event Name/Title Pangalan or title ng health event
4 Health Event Location Pangalan ng Opisina o Eskwelahan o Sitio o Street at Barangay, MunCity, Province, Region
5 Health Event Start date Petsa kung kailan nag-umpisa ang health event, o kung kailan unang nagkaroon ng kaso
6 Number of cases Ilan ang bilang ng kaso o mga nagkasakit, suspect man o confirmed dahil sa event na ito
7 Description of cases Age, sex at iba pang available na impormasyon, halimbawa: MinAge=2yrs, MaxAge=34yrs,
AveAge=10yrs, Female=57%, Pregnant=1%, Hospitalized=10%, Unvaccinated=35%, IPs=75%
8 Number of deaths Ilan ang bilang ng mga namatay dahil sa event na ito
9 Description of deaths Age, sex at iba pang available na impormasyon, halimbawa: MinAge=2yrs, MaxAge=34yrs,
AveAge=10yrs, Female=57%, Pregnant=1%, Hospitalized=10%, Unvaccinated=35%, IPs=75%
10 Local Response By Whom Progress Dates/Remarks/Notes
(Name of Office or Name of (Done/Ongoing/ (Details or
Individual) Halted/Planned) Other Information)
A. Case Management … ... …
B. Specimen Collection … ... …
C. Prophylaxis … ... …
D. Field Investigation … ... …
E. Information Sharing … ... …
Program … ... …
F.
Management
G. Health Education … ... …
11 Status of health event ...
12 Assistance needed Yes or No Details Remarks
A. Technical Support No … …
B. Human Resource No … …
C. Drugs & Medicines No … …
D. Supplies/Logistics Yes … …
E. Info Materials No … …
/NTO
ESR Form Rev.3.20180619 (NXXDMY5)
FOR MORE INFO, VISIThttps://www.resu.online
F. EPI Investigation No … …
13 Remarks/Notes
14 Laboratory Tests Done Name of Lab Facility Lab Test Done Result Remarks
… … … …
15 Assessment ALARM 3 (REGION + PROVINCE + MUNCITY TEAM RESPONSE)
☐ Unknown disease or unknown diagnosis
☐ Emerging (new) or re-Emerging disease
☐ Disease with epidemic potential
ALARM 2 (PROVINCE + MUNCITY TEAM RESPONSE + SUPPORT FROM REGION)
☐ Number of cases is continually increasing despite continuous health intervention
☐ Number of cases or deaths is more than expected compared to available records
☐ Number of hospitalized cases is more than expected (upsurge)
ALARM 1 (MUNCITY TEAM RESPONSE + SUPPORT FROM PROVINCE/REGION)
☐ No available or limited medical capacity for case management (hospital or expert)
☐ No available or limited laboratory capacity for confirmation (equipment or supplies)
☐ No available or limited drugs/medicines for management & prophylaxis
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FOR RESU USE ONLY- - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - -
990 RESU Notification/Update D/T 1st Reported to RESU Date Time Via:...
D/T of this Report/Update Date Time Via: ...
Initiated Surveillance & Response Protocol on
991 Information Sharing Coordinated with the following for necessary response: Date/Remarks
Protocol
Informed RD/ARD of this notification/update …
Informed Divisions/Units/Sections concerned …
Shared with Epi Bureau for info/augmentation of support …
992 Prepared, Reviewed and Regional Surveillance Officer
Cleared By
ALAIN DJ. AZANA, RN
RESU Head
NOEL T. OROSCO, RN, PHSAE
Assistant Regional Director
MA. VILMA V. DIEZ, MD, MHA, PHSAE, MNSA,
CESO IV
OIC-Regional Director
MARIO S. BAQUILOD, MD, MPH, CESO IV
DISCLAIMER: Every effort has been made to provide accurate, up-to-date information. However, the knowledge base is dynamic and errors can occur. By using the information
contained in this form, the reader assumes all risks in connection with such use. RESU MIMAROPAshall not be held responsible for errors, omissions nor liable
for any special, consequential or exemplary damages resulting, in whole or in part, from any reader's use or reliance upon this material.
/NTO
ESR Form Rev.3.20180619 (NXXDMY5)
