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FORM 2
PREVENTION AND CONTROL OF DISEASE ORDINANCE
(Cap. 599)
Notification of Infectious Diseases other than Tuberculosis
Particulars of Infected Person

Name in English: 

Name in Chinese: 

Age / Sex:  

I.D. Card / Passport No.: 

Residential address: Telephone No.
(Home) :

(Mobile) :

(Office / school / others):

Name and address of workplace / school:
Job title / Class attended:
Hospital / Clinic sent to (if any):  

Hospital / A&E No.:  

Disease ["√"] below Suspected/Confirmed on _______ / _______ / ________ (Date: dd/mm/yyyy)
 

Acute poliomyelitis
Haemophilus influenzae type b infection (invasive)
Rabies
Amoebic dysentery
Hantavirus infection
Relapsing fever
Anthrax
Invasive pneumococcal disease
Rubella and congenital rubella syndrome
Bacillary dysentery
Japanese encephalitis
Scarlet fever
Botulism
Legionnaires' disease
Severe Acute Respiratory Syndrome
Chickenpox
Leprosy
Shiga toxin-producing Escherichia coli infection
Chikungunya fever
Leptospirosis
Smallpox
Cholera
Listeriosis
Streptococcus suis infection
Community-associated methicillin-resistant Staphylococcus aureus infection
Malaria
Tetanus
Creutzfeldt-Jakob disease
Measles
Typhoid fever
Dengue fever
Meningococcal infection (invasive)
Typhus and other rickettsial diseases
Diphtheria
Middle East Respiratory Syndrome
Viral haemorrhagic fever
Enterovirus 71 infection
Mumps
Viral hepatitis
Food poisoning
Novel influenza A infection
West Nile Virus Infection
  Number of persons known to be affected: _______
Paratyphoid fever
Whooping cough
  Place and district of consumption
(e.g. “XX Restaurant in Mongkok”):
Plague
Yellow fever
 

___________________________________________ ___________________________________________

Psittacosis
Zika Virus Infection
 

Date of consumption: _________________________

Q fever    

Notified under the Prevention and Control of Disease Regulation by 


Dr. ______________________________ of ___________________________Hospital / Clinic / Private Practice

(Full Name in BLOCK Letters)

_________________________Ward / Unit / Specialty on ______ / _______ / ________ (Date: dd/mm/yyyy)

Telephone No.: _______________

Fax No.: _______________

___________________ 
(Signature)
Remarks: 

DH 1(s)(Rev. February 2016)



Last Revision Date : 15 Aug 2016