CDC Advisory 00235 - Medical Surveillance Form for Hurricane Katrina Evacuees

This is an official CDC Health Advisory Distributed via Health Alert Network September 09, 2005, 9:30 EDT (09:30 AM EDT)


This interim form is intended to be used for surveillance for medical conditions of public health importance among evacuees residing in shelter facilities or evacuation centers. The form can be used on a daily basis to record numbers of evacuees with specific infectious syndromes, mental health conditions, injuries and chronic diseases, for possible public health interventions. The form also can be used to identify areas in which a specific facility may need assistance or additional resources (e.g., physician staffing, medications, sanitation).

The form is available online at