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        Sentinel Provider Reports of Influenza-Like Illness (ILI)                   

 

       
       

  Yes        
           
           
Number of Patients with ILI:    
 

Influenza-Like Illness

Fever (>100oF {37.8oC} oral or equivalent) AND Cough and/or sore throat
(in the absence of a known cause)
   
   
  25 - 49  Years  
  50  
  > 64  Years                                                              

Total Number of Patients Seen
for Any Reason  

       
                                                       

These cells cannot be left blank!!

    

Person Submitting Report