Medical Record Abstraction Form Template

Key points

  • Health officials can use this form to collect clinical and epidemiologic data.
  • It can help confirm and classify a Legionnaires' disease case in a patient with a complicated clinical history.
  • Customize this form for outbreaks in healthcare settings and complete it for confirmed or suspected cases associated with the outbreak.
Image of the first page of the medical record abstraction template.
Format: PDF
Dimensions: 8.5 by 11 inches
Page count: 8
Language: English (US)
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Image of the first page of the medical record abstraction template.

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Image of the first page of the medical record abstraction template.

Medical Abstraction Template

This form collects clinical and epidemiologic data, and it can help confirm and classify a case of L...
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Content Source:
National Center for Immunization and Respiratory Diseases; National Center for Environmental Health