New Jersey Department of Health

Communicable Disease Service	SCABIES CASE LINE LIST: RESIDENTS
E -
Facility Name

Reported By

Telephone/Email

Report Date

Resident

Initials	Age	Gender	Unit or Wing	Room Number	Symptom Date Onset	Symptoms	MD Diagnosed (Y/N)	Confirmatory Diagnostic Testing	Treatment	Comments
Burrows	Rash	Severe Itching	Skin Excoriation
Skin Scraping	Test Date	Treatment Done	Initial Treatment Date	Repeat Treatment Date
1
2
3
4
5
6
7
8
9
10
CDS-34

JUL 14

CDS-34, Scabies Case Line Listing - Residents

EWhite

2014-06-26

NJDOH