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Get As Soon As Possible, Notify And Send Completed Form To: 1) Your Local/state Health Department, And

(eocreport cdc.gov, subject line: MERS Patient Form) or fax (770-488-7107). If you have questions, contact the CDC Emergency Operations Center (EOC) at 770-488-7100. Today s Date: STATE ID: STATE: COUNTY: Interviewers: Name: Phone: Email: Sex: M F Age: yr mo Residency: US resident non-US resident, country:.

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