"Morning (Am)/Evening (Pm) Fever Monitoring Chart Template" - Hillsborough County, Florida

Morning (Am)/Evening (Pm) Fever Monitoring Chart Template is a legal document that was released by the Florida Department of Health - a government authority operating within Florida. The form may be used strictly within Hillsborough County.

Form Details:

  • Released on October 3, 2014;
  • The latest edition currently provided by the Florida Department of Health;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Florida Department of Health.

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Download "Morning (Am)/Evening (Pm) Fever Monitoring Chart Template" - Hillsborough County, Florida

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Fever Monitoring Chart: Morning (AM) and Evening (PM) for 21 days
 Self-Reported  Public Health Observed
Name:_______________________________________________
Date Left Ebola-Impacted Country:________________________
Date Returned to the United States:________________________
Day:
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
Date:
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
Time of Check:
Symptoms
Temperature (°F)
Severe headache
Muscle/Joint aches
Vomiting or Diarrhea
Stomach pain
Bleeding or bruising
Fatigue/Weakness
Fever reducer taken?
Day:
Day 11
Day 12
Day 13
Day 14
Day 15
Day 16
Day 17
Day 18
Day 19
Day 20
Day 21
Date:
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
Time of Check:
Symptoms
Temperature (°F)
Severe headache
Muscle/Joint aches
Vomiting or Diarrhea
Stomach pain
Bleeding or bruising
Fatigue/Weakness
Fever reducer taken?
If you have a fever > 101.5°F (38.6°C) or have any symptoms of Ebola, call Public Health immediately at (813) 307-8000. Do not leave your home or travel anywhere.
If you are sick, limit contact with other household members.
Avoid using fever-reducing medications (Ibuprofen, Motrin, Aleve, Aspirin, Tylenol, Acetominophen, Naproxen sodium) during the 21-day monitoring period.
Morning (AM) and Evening (PM) temperatures must be taken at least 8 hours apart.
Date Created: October 3, 2014
Fever Monitoring Chart: Morning (AM) and Evening (PM) for 21 days
 Self-Reported  Public Health Observed
Name:_______________________________________________
Date Left Ebola-Impacted Country:________________________
Date Returned to the United States:________________________
Day:
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
Date:
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
Time of Check:
Symptoms
Temperature (°F)
Severe headache
Muscle/Joint aches
Vomiting or Diarrhea
Stomach pain
Bleeding or bruising
Fatigue/Weakness
Fever reducer taken?
Day:
Day 11
Day 12
Day 13
Day 14
Day 15
Day 16
Day 17
Day 18
Day 19
Day 20
Day 21
Date:
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
AM
PM
Time of Check:
Symptoms
Temperature (°F)
Severe headache
Muscle/Joint aches
Vomiting or Diarrhea
Stomach pain
Bleeding or bruising
Fatigue/Weakness
Fever reducer taken?
If you have a fever > 101.5°F (38.6°C) or have any symptoms of Ebola, call Public Health immediately at (813) 307-8000. Do not leave your home or travel anywhere.
If you are sick, limit contact with other household members.
Avoid using fever-reducing medications (Ibuprofen, Motrin, Aleve, Aspirin, Tylenol, Acetominophen, Naproxen sodium) during the 21-day monitoring period.
Morning (AM) and Evening (PM) temperatures must be taken at least 8 hours apart.
Date Created: October 3, 2014
Instructions for the Fever Monitoring Chart
1.) Name: Fill in your First name, Middle Initial, and Last name.
2.) Self-Reported vs. Public Health Observed Checkbox: If you are fever monitoring yourself, check the “Self-Reporting” box. If Public Health
employees are performing fever monitoring for you, check the “Public Health Observed” box.
3.) Date Left Ebola-Impacted Country: Fill in the date (DD/MM/YY) you left the Ebola-impacted country.
4.) Date Returned to the United States: Fill in the date (DD/MM/YY) you returned to the United States.
5.) Date: Fill in the date (DD/MM/YY) you perform your fever and symptom monitoring in the appropriate row and column. “Day 1” = the day
you left the Ebola-impacted country. If you did not begin your fever monitoring on “Day 1”, begin recording on the appropriate “Day #”
column.
6.) Time of Check: Fill in the time you perform your AM and PM fever checks in the appropriate row and column.
Recording Temperature and Symptoms
7.) Temperature: Take your oral temperature in the morning (AM) and in the evening (PM) and record the numeric value in degrees
Fahrenheit in the appropriate row and column. Morning (AM) and evening (PM) temperatures must be taken at least 8 hours apart.
8.) For all other symptoms, including severe headache, muscle/joint aches, vomiting, diarrhea, stomach pain, bleeding or bruising, and
fatigue/weakness: please mark either “Y” for Yes if you have the symptom or “N” for No if you do not have the symptom. Do not leave any
spaces blank.
9.) Fever-Reducer Taken?” Mark “Y” for Yes if you have taken a fever-reducing medication in the past 12 hours and “N” for No if you have not
taken a fever-reducing medication in the past 12 hours. Avoid using fever-reducing medications (Ibuprofen, Motrin, Aleve, Aspirin, Tylenol,
Acetaminophen and Naproxen sodium) during the 21-day monitoring period.
If you have a fever > 101.5°F (38.6°C) or have any signs or symptoms of Ebola, call Public Health
immediately at (813) 307-8000 and do not leave your home or travel anywhere. If you are sick, limit
contact with other household members.
Date Created: October 3, 2014
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