Daily White House Report

Form Approved

OMB No. 0920-XXXX

Exp. Date XX/XX/20XX

Daily White House Report

1. Number of patients with Ebola virus infection ______

2. Clinical status of patients with Ebola virus infection: a) discharged, b) under care and stable, c) under care and critical, d) died

3. Number of contacts contacted today/total number of contacts

   1. Community : # contacted:_____ Total contacts _____

   2. Health Care workers: # contacted:_____ Total contacts _____

4. Number of contacts that develop Ebola virus disease:______

   

   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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

   
   
   

5. For each contact, what are the number of days remaining for each person being tracked in their 21 day cycle

Days of Monitoring Remaining	# of contacts
Completed Monitoring
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Total

Additional Information Collected in CDC Evening Reports

6. Among contacts of the Ebola cases, Patients Under Investigation

   1. Clinical status: _______________________

   2. Test results ________________

1