New default icon

Available on

Apple Android Windows

Lyme Disease Investigation - Department of Health (New Jersey) Mobile App

The surveillance definition of Lyme disease as specified by the Centers for Disease Control is : 1) Erythema migrans, or 2) at least one late manifestation of Lyme disease and laboratory confirmation of infection. Late manifestations of Lyme disease include those muscloskeletal, neurologic or cardiac symptoms as listed under Section IV of this form. Other information captured includes lab data, patient information, and the treating physician.

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

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Lyme Disease Investigation - 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 textbox

    Name

  • Ico date

    Date of Birth

  • Ico textbox

    Age

  • Ico dropdown

    Sex

  • Ico dropdown

    Ethnicity

  • Ico multiline

    Address

  • Ico textbox

    County

  • Ico textbox

    Municipality of Residence:

  • Ico textbox

    Telephone Number:

  • Ico textbox

    Name of Health Department:

  • Ico textbox

    Name of Investigator:

  • Ico textbox

    Telephone No.

  • Ico textbox

    Name:

  • Ico textbox

    Agency:

  • Ico textbox

    Telephone No.

  • Ico textbox

    Name:

  • Ico multiline

    Address:

  • Ico textbox

    Telephone Number:

  • Ico date

    Date of Onset:

  • Ico statictext

    Check all that apply:

  • Ico statictext

    A.

  • Ico checkbox

    Erythema migrans (Size: >5 cm)

  • Ico statictext

    B.

  • Ico checkbox

    Arthritis characterized by brief (weeks or months) attacks of object joint swelling

  • Ico statictext

    C.

  • Ico checkbox

    Cranial neuritis

  • Ico checkbox

    Lymphocytic meningitis

  • Ico checkbox

    Radiculoneuropathy

  • ...and More!

Related Apps... and they're all free for GoCanvas subscribers!

App Name

Home Healthcare Customer Assessment Form

Capture all important customer details with this Home Healthcare Customer Assessment Form. Includes customer information,...

App Name

Medical History Form - Motorola Solut...

The Medical History Form - Motorola Solutions mobile app makes it easy for health care providers to manage details about t...

App Name

Sanitary Sewer Requirements Checklist

The Sanitary Sewer Requirements Checklist mobile app provides a summary of general requirements for proposed improvements ...

App Name

Child Care Center Indoor Environmenta...

Use this online environmental health assessment to determine the historical and current uses of the building as well as th...

App Name

Development of Sanitation Program: We...

This Development of Sanitation Program: Wet Cleaning Mobile App facilitates an important prerequisite sanitation program t...

App Name

LVN On Call Communication Protocols: ...

The LVN On Call Communication Protocols: Medication or Diagnosis Changes or Concerns mobile app is an easy to follow Medi...

App Name

Pre Anesthesia Health Assessment Que...

Please answer all questions in the Pre Anesthesia Health Assessment Questionnaire mobile app as accurately as possible. Th...

App Name

Family History

The Family History mobile app allows caregivers and family members to maintain an electronic family health history using a...

More Information


  • Creator: Team GoCanvas
  • Language: English
  • Country: United States of America
  • Type:
  • Tags:
  • Categories:
    no categories defined yet.

Recent Blog Posts