0920-0004 Influenza-Like Illness (year-round) 55.20E

U.S. Influenza Sentinel Provider
Surveillance Network

State & Local
Health Departments

Participating
Providers

2005 -2006
Workfolder

DEPARTMENT OF HEALTH & HUMAN SERVICES • Centers for Disease Control and Prevention

.

CDC 55.20E REV. 06/2005 page 1 of 4

DEPARTMENT OF
HEALTH & HUMAN SERVICES
Centers for Disease Control
and Prevention (CDC)
Atlanta, Georgia 30333

U.S. I NFLUENZA S ENTINEL P ROVIDER
S URVEILLANCE W ORKFOLDER

U.S. INFLUENZA SURVEILLANCE
INFLUENZA BRANCH
DIVISION OF VIRAL AND RICKETTSIAL DISEASES

October 2, 2005 – September 30, 2006

INFLUENZA-LIKE ILLNESS (ILI) is defined as:

Provider ID:
Password:

Fever (>100°F [37.8°C] , oral or equivalent) AND cough and/or sore throat
(in the absence of a KNOWN cause other than influenza).

Summer 2006

2005–06 Season
Week
Ending
Date

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

CDC
Date
Code

Form Approved
OMB No. 0920-0004

0–4
Yrs.

5–24
Yrs.

25–64
Yrs.

>64
Yrs.

Total
Patients
Seen*

Week
Ending
Date

CDC
Date
Code

8

0540

JUN 3

0622

15

0541

10

0623

22

0542

17

0624

29

0543

24

0625

5

0544

1

0626

12

0545

8

0627

19

0546

15

0628

26

0547

22

0629

3

0548

29

0630

10

0549

5

0631

17

0550

12

0632

24

0551

19

0633

31

0552

26

0634

7

0601

2

0635

14

0602

9

0636

21

0603

16

0637

28

0604

23

0638

4

0605

30

0639

11

0606

18

0607

25

0608

4

0609

11

0610

18

0611

25

0612

1

0613

8

0614

15

0615

22

0616

29

0617

6

0618

13

0619

20

0620

27

0621

CDC 55.20E REV. 06/2005 page 2 of 4

JUL

AUG

SEP

0–4
Yrs.

5–24
Yrs.

25–64
Yrs.

>64
Yrs.

Total
Patients
Seen*

*Total Patients seen for any reason = (non-ILI + ILI)

Thank you for participating in the
U.S. Influenza Sentinel Provider
Surveillance System.
Please do not discard this workfolder.
A postage paid envelope will be provided for
you to return the workfolder to CDC at the end
of the season (or summer if you participate in
year-round surveillance).

INFLUENZA-LIKE ILLNESS (ILI) is defined as:
Fever (>100°F [37.8°C] , oral or equivalent) AND cough and/or sore throat
(in the absence of a KNOWN cause other than influenza).
The presence or absence of other symptoms, such as body aches, fatigue, or vomiting, should be disregarded when classifying a patient as having an ILI.
Although this clinical definition by itself is very general, when combined with information on circulating viruses, the information on influenza-like illness
activity provides an excellent picture of influenza activity in the United States.

INSTRUCTIONS FOR INTERNET REPORTING
The sentinel provider Internet reporting site should be accessible by both Netscape (Version 5.0 and above)
and Internet Explorer (Version 5.0 and above) browsers.
To access the influenza sentinel provider Internet reporting system, go to:

http://www2.ncid.cdc.gov/flu/
Enter your provider ID code and password which can be found on the previous page and select Submit.
You will now be on the Main Menu page. From this page you may either enter or view your data.
To enter data:
1. Select Enter Data.
2. Select the four digit date code (e.g. 0540) for the week you wish to report and enter your data. Use the
enter or tab key to move from one data field to the next. Indicate if the report is an update from a
previously entered repor t .

Influenza Surveillance Program

Sentinel Provider Internet Reporting System
Data Input Page
1. Provider ID Code:

77001

2. Date Code:

0540 (Oct 8, 2005)

3. ILI AGE 0-4:

0

4. ILI AGE 5-24:

0

5. ILI AGE 25-64:

0

6. ILI AGE OVER 64:

0

7. TOTAL PATIENTS SEEN:

100

8. Is this a revision of data reported
on an earlier date?
Submit

NO ■

YES ■

Reset

Go To Main Menu

3. Select Submit. Your data has been transmitted to CDC and will be displayed on the screen. If the data
displayed are incorrect, select Go To Main Menu, re-enter the correct report, and indicate that this entry is a
revision of previously reported data.
4. Select Go To Main Menu. This will take you back to the Main Menu page. If you wish to enter data for
additional weeks, repeat steps 1 through 4.
In addition to entering and viewing your own data, you can also view the most recent influenza activity update.
CDC 55.20E REV. 06/2005 page 3 of 4

SENTINEL PROVIDER REPORTS
OF INFLUENZA-LIKE ILLNESS (ILI)

FORM APPROVED
OMB NO. 0920-0004

2005-2006 Influenza Surveillance

Report for the 7-day period ending ___/___/___
ID Number

(Period ends Saturday at midnight)

Check if
Revised
Report

Number of Patients with ILI
0-4 yrs.
(Pre-school)

5-24 yrs.
(School age)

25-64 yrs.
(Adults)

Influenza-like Illness
Fever (≥100° F [37.8° C], oral or
equivalent)
-AND cough and/or sore throat
(in the absence of a known cause other than influenza)

>64 yrs.
(Older Adults)

Total Number of Patients Seen For Any Reason
(Total of ILI + Non-ILI cases for all age groups combined)

DO NOT LEAVE BLANK.
WITHOUT THIS NUMBER, THE REPORT CANNOT BE USED.

FAX THIS FORM TO 1-888-232-1322
(NO COVER SHEET IS REQUIRED)
Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to DHHS Reports
Clearance Officer; Paperwork Reduction Project (0920-0008); Rm 531H, H. H. Humphrey Bg.; 200 Independence Ave., SW, Washington, DC 20201.

CDC 55.20
REV. 6/05