10.7 APPENDIX G - EXAMPLES OF DOCUMENTATION LOG

Please note, some of the examples in the Appendices may be outdated and may have changed. Those changes may not be reflected in this document.

Example #1: Courtesy of Colorado Bureau of Public Health

INTERNET PARTNER NOTIFICATION LOG SHEET

Partner # Email Date Website Name Partner’s Email Email Script # AM Logon Time PM Logon Time Notes/Outcome of Activity Disease Verification (3rd Email) Closure Code
 
 
 
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Your Name:                                                                                                                 DIS # & State:

Initiation Date:                                                                                                           OP Id # and Disease:

Internet-based Partner Services Supervisory Website Log

Date Website Log In Time Log Out Time Purpose Staff/Sups Initials
 
 
 
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Example #2: Courtesy of Arkansas Department of Health

INTERNET-BASED PARTNER NOTIFICATION LOG SHEET

Month: ________________                        Year: ___________________

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Field Record # Date Recd P1 to: Screen Name/ Email Address Website Dis No. Attempt and Outcome #1 Attempt and Outcome #2 Attempt and Outcome #3 Dispo/Date SN DB Notes