Nevada Enhanced Influenza Subtype Monitoring

This survey helps the Nevada Office of State Epidemiology (OSE) track specimens that are being sent to the Nevada Public Health Labs for influenza A subtyping. Please submit one response for each specimen submitted.

If you have any issues with the survey, please contact OSE at stateepi@health.nv.gov.

Thank you for your efforts to enhance influenza surveillance in Nevada this summer!

Submitting facility name

If you cannot find your facility in this list, please select "OTHER" and specify the facility name in the text field that will appear.

* must provide value

Please specify the healthcare facility that is submitting this specimen.

Please select the county your facility is in

* must provide value

Date of specimen collection

* must provide value

M-D-Y

Patient first name

* must provide value

Patient last name

* must provide value

Patient date of birth

* must provide value

M-D-Y

Accession number

Please select the public health lab where the specimen was sent

* must provide value

Please select the reason(s) this patient was indicated for subtyping

"Compatible symptoms" may be found on the CDC's webpage

* must provide value

Patient is hospitalized and positive for Influenza A

Patient has compatible symptoms and reported animal contact

Patient has compatible symptoms and reported raw dairy consumption

Other

Please enter the other reason the patient was indicated for subtyping

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.