Tracking Cholera
Tracking the outbreak of cholera (استطلاع ميداني لمراقبة الكوليرا)

الرجاء إبقاء اسم المريض مجهولاً قدر الإمكان (Please keep patient identity anonymous whenever possible.) A Humanitarian Tracker Project.  For more information email us: info@humanitariantracker.org
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In your opinion, how does one get cholera? *
Demographics
Patient identifier
Name (if anonymity waived), cell phone #, photo identification #
Gender
Patient's gender
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Age
Approximately how old is the patient in years?
Occupation
Highest level of education
What is the highest level of education completed
Location
Nearest city (if not known then please select other)
Number of people living together
Of these people, how many are children?
Of these people, how many are adults?
Of the adults, how many bring income into the household?
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