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Form C: Cased-based data (light protocol )

Form C: Cased-based data (light protocol ). *. Hospital code :. *. Surveillance p eriod : From ( dd /mm/ yyy ):. *. Surveillance p eriod : To ( dd /mm/ yyy ):. *. Patient counter :. Age in years :. *. If < 2 years old , age in months :. *. Sex:. Male. Female. Unknown.

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