New Jersey Department of Health

Communicable Disease Service	SCABIES CASE LINE LIST: STAFF
E -
Facility Name

Reported By

Telephone/Email

Report Date

Initials	Location(s) Worked

Prior to Treatment	Usual Job Duties (e.g., patient care, housekeeping)	Symptom Date Onset	Symptoms	MD Diagnosed (Y/N)	Confirmatory Diagnostic Testing	Treatment	Comments
Burrows	Rash	Severe Itching	Skin Excoriation
Skin Scraping	Test Date	Treatment Done	Initial Treatment Date	Repeat Treatment Date
1
2
3
4
5
6
7
8
9
10
CDS-35

JUL 14

CDS-35, Scabies Case Line Listing - Staff

EWhite

2014-06-26

NJDOH