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Guillain-Barre Syndrome Report - Department of Health (New Jersey) Mobile App

This Guillain-Barre syndrome report for the department of health for New Jersey has been turned in to an application that can be accessed from your smartphone or tablet. It allows health officials record data on date of diagnosis, sensory loss, laboratory tests, and risk factors. Questions include electrophysiologic studies and name and title of person submitting report.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Guillain-Barre Syndrome Report - Department of Health (New Jersey) Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico date

    Date

  • Ico textbox

    CDRS ID No.

  • Ico textbox

    Full Name

  • Ico multiline

    Address

  • Ico textbox

    County

  • Ico textbox

    Sex

  • Ico textbox

    Date of Birth (Age)

  • Ico textbox

    Telephone Number

  • Ico statictext

    Race

  • Ico checkbox

    White

  • Ico checkbox

    Black

  • Ico checkbox

    American Indian

  • Ico checkbox

    Asian

  • Ico textbox

    Unknown/Other

  • Ico dropdown

    Ethnicity

  • Ico multiline

    Reporting Physician (Name, Address and Telephone No.

  • Ico multiline

    Hospital (Name, Address and Telephone No.

  • Ico date

    Date of Diagnosis

  • Ico date

    Onset Date of Illness

  • Ico textbox

    Deceased?

  • Ico dropdown

    Case Status

  • Ico textbox

    Clinical: Muscular weakness:

  • Ico textbox

    If yes, specify involved group of muscles:

  • Ico textbox

    Sensory loss:

  • Ico textbox

    If yes, specify location:

  • Ico statictext

    Risk Factors:

  • Ico checkbox

    Surgery:

  • Ico checkbox

    Immunization:

  • ...and More!

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More Information


  • Creator: Team GoCanvas
  • Language: English
  • Country: United States of America
  • Type: Reports
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