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Appendix PS-E

LOT SYSTEM FORMS

The lot system includes the major analytical points (MAP) sheet, the lot folder status sheet, an original interview record (73.54), the original patient information sheet, the reinterview record, the cluster interview record, the syphilis case analysis sheet, and copies of any field records (73.2936) associated with the case.

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Major Analytical Points Sheet

Lot Folder Status Sheet   CDC 73.4

Interview Record CDC 73.54

Interview Record Codes

Original Patient Information Sheet

Original Patient Information Sheet p.2

Reinterview Record

Reinterview Record p.2

Cluster Interview Record

Cluster Interview Record p.2

Field Record CDC 73.2936S

Field Record Codes

 

 



Page last modified: August 16, 2007
Page last reviewed: August 16, 2007 Historical Document

Content Source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention