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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

Confidential Outbreak Report
*Outbreak: 
Person Reporting Report Type: New  Update Report Date: 4/23/2014
*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:        
Outbreak Profile
(Note - if the outbreak is in a non-institutional setting, enter total ill in 1st question as well as how many people were potentially exposed in 2nd. Then skip questions 3-4.)
1. How many RESIDENTS have been ill?     8. What was the onset date of the first case?
2. How many RESIDENTS are there in this facility?     9. What was the onset date of the last case?
3. How many STAFF have been ill?     10. How many specimens are being tested?
4. How many STAFF are there in this facility?     11. What causative agent is suspected?
5. What is the average/estimated duration of
    symptoms?
    12. Has this agent been laboratory confirmed?
6. How many people were hospitalized?     13. Is the Outbreak ongoing?
7. How many people died?     
Comments:
This aggregate report is intended to fulfill disease notification requirements for outbreaks only. It does not fulfill individual case reporting requirements for South Dakota notifiable disease conditions.

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