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Case questionnaire for Campylobacteriosis

Summary

· This form is to be used when DH requests local government to collect specimens or samples as part of an infectious disease investigation.
· Please fax or email the completed form to Communicable Diseases Prevention and Control Unit (CDPCU) on fax: 1300 651 170 or email: cdi&r@health.vic.gov.au..
· Ensure container is clearly labelled with all relevant details and the appropriate MDU forms are completed. Keep sample refrigerated at all times.

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Owner:
Epidemiology and Surveillance,
Communicable Disease - Prevention and Control,
Chief Health Officer and Health Protection,
Wellbeing, Integrated Care and Ageing,
Department of Health
50 Lonsdale Street,
Melbourne, Victoria, 3000
Telephone: (61 3) 9096 9000