Submit Disease Report - WCSH HMIS

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Basic Info

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Disease Entry

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Reporting Period

Month *

Year *

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Department *

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Outcome Type *

Morbidity (Cases)

Mortality (Deaths)

Period:

Department:

Outcome:

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Disease Selection (ICD-11)

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Age & Sex Distribution

Age Group	Male	Female
< 1 year
1 – 4 years
5 – 14 years
15 – 29 years
30 – 64 years
≥ 65 years