Omi

cronCas
eDet
ail
s
AMC
Di
str
ictName:

Tal
uka/ZoneName: CZ
PHC/UPHCName: KALUPURUPHC
Vi
ll
ageName KALUPUR
Addr
ess:
Flat
/Hous
e/Apar
tmentNo.
: 25
40NRSODAGARNIPOLEOPP
BHESATVADO
Nameoft
hepat
ient
: MOMI
NMOJ
ABI
R
MbNo: 9081
0991
21
Age(
year
s): 36YEARS
Gender: FEMALE
Oc
cupat
ion: HOUSEWI
FE
Dat
eOfons
etSy
mpt
oms&i
tsHi
stor
y: 25
/12/2021

Comor
bidi
ty: NO
Int
ernat
ionalTr
avelHi
stor
yinl
ast1
5 NA
Days:

Dat
eofAr
riv
alI
nGuj
arat: NA
Loc
alTr
avelHi
stor
yinl
ast1
5Day
s: NA

RTPCRt
est
ingDat
e: 1
.Tes
tDat
e:26
-12-
2021 Repor
t:POSI
TIVE
 2.Tes
tDat
e: Repor
t:

3.Tes
tDat
e: Repor
t:

4.Tes
tDat
e: Repor
t:

RTPCRPos
iti
veDat
e: 26
-12-
2021
GenomeSequenc
ingSampl
eDat
e: 26
-12-
2021
Omi
cronPos
iti
veDat
e: 05
-01
-2022
"
Vac
cinat
ionSt
atus(0/1
/2): 2FULLYVACCI
NATED
Vac
cineName: COVI
SHI
ELD
st
Vac
cine1 Dos
eDat
e: 06
-05
-2021
Vac
cine2nd Dos
eDat
e: 02-
07-
2021
Pr
obabl
esour
ceofi
nfec
tion: 1
.Int
ernat
ionalTr
avel

2.Domes
ticTr
avel

3.pat
ientac
ont
actofpos
iti
vec
ase

4.ot
her

Gi
vedet
ail
sifOt
her
:S

Tot
alCont
act
s: 5
0
No.
ofPr
imar
y(Cl
ose)Cont
act
s: 1
0
RTPCRSampl
eofPr
imar
yCont
act
s: 5
RTPCRPos
iti
veofPr
imar
yCont
act
s: 0
No.
ofSec
ondar
yCont
act
s(LowRi
sk): 40
RTPCRSampl
eofSec
ondar
yCont
act
s: 00
RTPCRPos
iti
veofSec
ondar
yCont
act
s: 00
I
spat
ientac
ont
actofpos
iti
vec
ase? NO
I
fyes
,ty
peofc
ont
actwi
tht
hepos
iti
ve SOCI
AL
c
ase

Rel
ati
ons
hipofpos
iti
vec
asewi
tht
his NO
cas
e:

Dat
eofPos
iti
veCont
act: NO
Pat
ient
’sAdmi
ttedHos
pit
alName& HOMEI
SOLATEDON30-
12-
2021
Dat
e:

Pat
ientHeal
thCondi
tion: GOOD

Cont
ainmentZone: NO

Ac
tionTakenByHeal
thTeam: 1
.HI
STORYTAKI
NG
2.
COUNSELLLI
NG
3.
SURVELLANCEOFSOCI
ETY
4.
CONTACTTRACI
NG
5
.HOMEI SOLATI
ONOF
PATI
ENT.

Si
gn

CDHO/MOH