Toggle navigation Load unfinished survey Resume later Exit and clear survey Language: English - English English - English Français - French Nederlands (informeel) - Dutch (informal) default Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters. SGP_ALI Registration of new episode of ALI and ILI and acute diarrhea Identification (This question is mandatory) GP code (This question is mandatory) Startdate of registration week (monday) Date format: mm-dd-yyyy Open date/time selector Format: mm-dd-yyyy 1900-01-01 2037-12-31 MM-DD-YYYY (This question is mandatory) Activity code Actif Forgotten On holiday Illness Other: (This question is mandatory) How is your workload at present with caring for patients with (all) acute respiratory infections? The workload is very high The workload is rather high The workload is normal The workload is rather low The workload is very low ALI (This question is mandatory) Cases of ALI this week? Yes No Number of cases ALI < 1 year 1 - 4 year 5 - 14 year 15 - 19 year 20 - 64 year 65 - 84 year 85 year and + ILI (This question is mandatory) Cases of ILI this week? Yes No Number of cases ILI Only numbers may be entered in these fields. Cases < 1 year Cases 1 - 4 year Cases 5 - 14 year Cases 15 - 19 year Cases 20 - 64 year Cases 65 - 84 year Cases >= 85 year Cases GE Acute diarrhea (This question is mandatory) Cases of acute diarrhea this week? Yes No Number of cases acute diarrhea Only numbers may be entered in these fields. Cases Coproculture (cases yes) Hospitalisation (cases yes) Antibiotics (cases yes) < 1 year Cases Coproculture (cases yes) Hospitalisation (cases yes) Antibiotics (cases yes) 1 - 4 year Cases Coproculture (cases yes) Hospitalisation (cases yes) Antibiotics (cases yes) 5 - 14 year Cases Coproculture (cases yes) Hospitalisation (cases yes) Antibiotics (cases yes) 15 - 19 year Cases Coproculture (cases yes) Hospitalisation (cases yes) Antibiotics (cases yes) 20 - 64 year Cases Coproculture (cases yes) Hospitalisation (cases yes) Antibiotics (cases yes) 65 - 84 year Cases Coproculture (cases yes) Hospitalisation (cases yes) Antibiotics (cases yes) >= 85 year Cases Coproculture (cases yes) Hospitalisation (cases yes) Antibiotics (cases yes) Submit Load unfinished survey Resume later Please confirm you want to clear your response? Exit and clear survey ×
