Ebola Screening Form
- Los Angeles County
- Los Angeles County Public Health Acute Communicable Disease Control Program (LACDPH ACDC)
- Resource Updated:
- Jan. 08, 2015
About this Resource
Official California Department of Public Health form to screen patients for Ebola Virus Disease.
Hospital staff caring for patients under investigation or patients with confirmed Ebola virus disease (EVD).
- California Department of Public Health (CDPH) form to screen patients for Ebola Virus Disease (EVD).
- This form is intended to be utilized to collect key information for patients that have traveled to EVD affected areas and/or patients that have been in contact with an individual with known or suspected EVD.
- Completed Ebola Screening forms must be faxed to Acute Communicable Disease Control (ACDC) (Fax:213-202-5999).