Lyme Disease Investigation - Department of Health (New Jersey)

Form Template

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.

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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.

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