Intake Form
Persistence of Ebola Virus in Body Fluids of Ebola Virus Disease Survivors in Sierra Leone
Attachment1_IntakeForm.xlsx
Intake Form
OMB: 0920-1149
Document [xlsx]
Download: xlsx | pdf
| A1 Page 1 – Persistence of Ebola Virus in Body Fluids of Ebola Virus Disease Survivors |
|
|||||||||
| Attachment 1 — Intake Form | ||||||||||
| Date | Study Site | Participant Name | Age | Sex | Chiefdom | Ebola Treatment Unit Case Investigation Form Number | Survivor Certificate Number | EVD Discharge Certificate Number | National Identification Card Number | Assigned Unique ID |
|
||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
© 2024 OMB.report | Privacy Policy