2. Epi Week Number
3. School Name
   -- Select One --Alexander DoniphanAntioch MiddleBell PrairieBriarcliffChapel HillChouteauClardyCrestviewDavidsonDiscovery MiddleDogwoodEastgate MiddleElkhornEPiCExcelsior Springs HighExcelsior Springs MiddleFox HillFranklinGashlandGolden OaksGracemorHawthorneHeritage MiddleKearney Elem.Kearney HighKearney Jr. HighKearney MiddleKellybrookLakewoodLewisLewis and ClarkLiberty HighLiberty MiddleLiberty North OaksLiberty OaksLillian SchumacherLinden WestManor HillMaple Park MiddleMaplewoodMeadowbrookNashuaNew Mark MiddleNorth Kansas City HighNorthgate MiddleNorthviewOak Park HighOakwood ManorPin OaksRavenwoodRidgeviewShoal CreekSmithville HighSmithville MiddleSmithville PrimarySmithville UpperSouth Valley MiddleSouthviewStaley HighToppingWarren HillsWest EnglewoodWestviewWinnetonka HighWinnwood
5. District Name
   -- Select One --Excelsior SpringsKearneyLibertyNorth Kansas CitySmithville
6. School Population
8. Type of School
   -- Select One --ElementaryJunior High SchoolMiddle SchoolHigh School
12. Symptom
13. Number of cases this week only
    Enter "0" if you have no cases
15. Fever/fever-related symptoms
    Oral temperature >/= 100 degrees F
16. Case Count
18. Diarrhea
19. Case Count
21. Vomiting
22. Case Count
24. Respiratory Illness
    Congestion, runny nose, cough, wheeze, stuffy nose, respiratory allergies
25. Case Count
27. Rash
    Chicken pox, scabies, hives, poison ivy
28. Case Count
30. Sore throat
31. Case Count
33. Headache
34. Case Count
37. Asthma attacks and asthma prevention
    Preventative puffs
38. Case Count
40. Stomach ache
41. Case Count
45. Please include any notes from the boxes above (details on a particular symptom, information you think we should know, etc.)
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