Medical Record Abstraction Form Template

Key points

  • Health officials can use this form to collect clinical and epidemiologic data.
  • It can help confirm and classify a Legionnaires' disease case in a patient with a complicated clinical history.
  • Customize this form for outbreaks in healthcare settings and complete it for confirmed or suspected cases associated with the outbreak.
Format: PDF
Dimensions: 8.5 by 11 inches
Page count: 8
Language: English (US)

Additional formats