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

Surveillance and Reponse 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
/
XCityHealth 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: ___ Date: _____________
Name of RHU/CHO/PHO/CHD):_________________________________

This report was approved by: __________________________________ Date: _____________

(Name & Signature of Head of Office/Unit/Hospital/Clinic)

List of Notifiable Diseases/Syndromes

Indicate the number of case/s in the corresponding line of 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 Encephalitis Syndrome
_____ Anthrax ____ Acute Hemorrhagic Fever Syndrome
_____ Human Avian Influenza ____ Acute Viral Hepatitis
_____ Hand Foot and Mouth Disease (HFMD) ____ Bacterial Meningitis
_____ Measles ____ Cholera
_____ Meningococcal Disease ____ Dengue
_____ Neonatal Tetanus ____ Diphtheria
_____ Paralytic Shellfish Poisoning ____ Influenza-like Illness
_____ Rabies ____ Leptospirosis
_____ Severe Acute Respiratory Syndrome (SARS) ____ Acute Gastroenteritis
_____ Malaria ____ Non-neonatal Tetanus
_____ Outbreaks ____ Pertussis
 Clusters of Diseases ____ Typhoid and Paratyphoid Fever
 Unusual Diseases or Threats
_____ COVID-19

Category I: Notify simultaneously the PHO, CHD and NEC within 24 hoursof 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 FRIDAYof the week to the next higher
level using the Case Report Form (CRF)
Reminder: Submission is every FRIDAY of the week. The weekly report should include this page (Summary Page), Case
Investigation Forms (CIF) and the Case Report Form (CRF)

“Let’s help prevent epidemics”