Data Collection

Health departments should immediately report patients under investigation (PUIs) to CDC using the MERS PUI short form below. Please contact the CDC MERS Team if you have any questions: DomesticMERS@cdc.gov.

There are now two options to submit a completed MERS PUI short form to CDC:

1. Online
   Health departments can now fill out the PUI short form online which automatically enters it into a secure database and submits the information to CDC. To begin completing PUI short forms online, state health departments should contact the CDC MERS Team at DomesticMERS@cdc.gov to obtain a unique state-specific password. Once you have a password, click the online PUI short form link below, select your state from the drop-down box, enter your unique state-specific password obtained from CDC, and click “Login.” Within the form, enter a unique State ID for the PUI and click “Load / Check STATE ID” to begin entering the information. Click “Save” when completed. In the near future, health departments will have access to their state-specific PUI short form information, including previously submitted short forms.

   • Online Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form, online version 6.2 (updated Dec 2015)

2. By FAX or email
   Alternatively, health departments may download, print, and send the completed investigation short form below by FAX to CDC at 770-488-7107 or attach the short form to an email to eocreport@cdc.gov (subject line: MERS Patient Form).

   • Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form, version 6.2 (Dec 2015)
     • Download PDF file [1 page]
     • Download Microsoft Word file [1 page]