<p>Line Listing for Respiratory Illness Outbreaks List for: Residents/patients____ Employees____ (check one) Unit+:______</p><p>Name of Facility:______Address:______Contact Person:______Telephone:______</p><p>Signs and symptoms Laboratory results</p><p> l ) ) ) ) ) t t t + s s g a * e h h d . x i a a e e s _ n n R s e e e</p><p> a n t e t N s e g n e i r p s t t t e g e s i e n _ e e / e C e o a o h z u t a n u S a a a i r g g _ h Y n h o A k i n P c e m l t i i</p><p> l o N r l r h N _ D U D D a l C t t a e O A r</p><p>I a ( ( ( m C m t</p><p> u e t T t b _ y - </p><p>- n n a z i</p><p> f</p><p> f u c o & i f e n _ f n t h n a</p><p> i l A N e n i p o n</p><p> n o e t ( s V</p><p>_ D o r e / n c</p><p> s * c</p><p> e</p><p> e o o a n m d e s t e _ v i s Y c o u i o i s i u f t n n t e t P t u h l u _ i S i a s l R p g s H t f e a s o r</p><p> g D _ h e i V u a i f e u n n e M D u t i _ S s i I l n</p><p> h R </p><p> g g p a t l c _ e a r a s r n r n c l a a</p><p> d c r R o l l r u r o o z</p><p> o a c i e . e N a y o C h n C i D V o v / h o n</p><p> i a r c S e c t Y t r o a e e N u i o -</p><p> n z t l O R g f X c n ( A m m</p><p> e n a e r I u L o B u e e l o v f n R</p><p>Name e n P I F ) ) e t e t a a D ( D (</p><p>Use a separate line list for residents on each unit, if possible.</p><p>*List shift and unit (or ward) for employee cases</p>