ࡱ> TVS{  bjbjzz rH2LL$PLf|$:222 ' 3W$Y$Y$Y$Y$Y$Y$$&J)}$;  ;;}$22$ sss;22W$s;W$ss:!,"2k~"! C$$<$!R*\*"*"(;;s;;;;;}$}$G,;;;$;;;;*;;;;;;;;;L l: Case Notification Request (CNR) Statement As a requirement of the Council of State and Territorial Epidemiologists (CSTE), this statement needs to be completed by the CDC Subject Matter Expert responsible for the prevention and control of a condition being proposed for inclusion on the CSTE Official List of Nationally Notifiable Conditions. A completed CNR statement must accompany the CSTE position statement template for placing conditions on the CSTE National Notifiable Condition list. This requirement is outlined in CSTE position statement 08-EC-02 ( HYPERLINK "http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS/08-EC-02.pdf" http://c.ymcdn.com/sites/www.cste.org/resource/resmgr/PS/08-EC-02.pdf) Nationally Notifiable Condition: _________________________________ Date: ____/______/______ CDC programmatic unit: _______________________________________ CDC staff completing form: ___________________________________ CDC staff contact info_______________________ (email) and _______________________________________ (phone) Please check requested timeframe for case notification to CDC: ___ Immediate notification (Extremely Urgent) ___ Immediate notification (Urgent) ___ Standard notification ___ Both Immediate and Standard notification. Notification timeframes may be specific to sub-types of condition or circumstances associated with the event. Please Specify: ______________________________________________________________________________ Please check requested case classification(s) for case notification to CDC: ___ Confirmed cases ___ Probable (presumptive) cases ___ Suspected (possible) cases ___ All cases prior to classification Instructions: For all conditions answer questions 1-5 below. In addition, for conditions for which immediate notification is requested (for either all or some of cases), please also answer questions 6-10. Complete this section for all Conditions1. What purposes, goals, and objectives will be met by case notification to the national level? 2. How will the cumulative or aggregate case data be used, including both standard periodic analyses of nationally-compiled data and anticipated ad-hoc analyses? 3. How frequently will information be provided to states and territories regarding the results of analyses of the compiled case data? 4. What is the anticipated schedule of release of published data based on case notifications, as well as any rules for restrictions on the printing of counts of case data? 5. What is the anticipated plan for the re-release of case data, including re-release to WHO or other parties? Conditions Requiring Immediate Notification YesNo 6. Does this condition have special importance for the international health regulations [i.e., a public health event that may constitute a "public health emergency of international concern" as defined in IHR 2005 including, but not limited to: smallpox, novel influenza, wild-type polio, Severe Acute Respiratory Syndrome (SARS)]?  7. Is this condition included on the list of Category A possible bioterrorism agents and toxins?  8. Has this condition or disease been declared eliminated (absence of endemic disease transmission) in the United States or eradicated globally? 9. Why is immediate case notification to the national level necessary? 10. How will CDC respond to the case notification?  Instructions for Returning Completed CNR Statements: Please email completed forms to the Council of State and Territorial Epidemiologists (CSTE) national office (email address:  HYPERLINK "mailto:positionstatements@cste.org" positionstatements@cste.org) and to CDCs National Notifiable Diseases Surveillance System (email address:  HYPERLINK "mailto:NNDSSweb@cdc.gov" NNDSSweb@cdc.gov).      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