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South Dakota Confidential Disease Report
South Dakota Department of Health
Office of Disease Prevention
SDCL 34-22-12 and ARSD 44:20     Reportable Disease List

Weekly Report of Influenza Rapid Antigen Testing
Person Reporting   Report Date: 4/18/2014
*First Name: *Last Name: Suffix:
*Phone: Ext: Email:
Outbreak Facility
*Facility Name:
  If your facility name is not in the list above, please spell out the name (no abbreviations) in the text box below before submitting this form.
  Other Facility Name: 
Address
City: State: Zip:
Phone:        
Rapid Antigen Testing Data
*Total specimens tested:
  *Specimens positive for influenza A: 
  *Specimens positive for influenza B: 
*From Date: (mm/dd/yyyy)
*To Date: (mm/dd/yyyy)
       
Comments:
This aggregate report is intended to fulfill disease notification requirements for weekly influenza rapid antigen reports only. It does not fulfill individual case reporting requirements for laboratory confirmed cases (DFA, PCR, or culture), influenza hospitalizations, or influenza deaths.
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