Human Infection with 2019 Novel Coronavirus Person Under Investigation (PUI) and Case Report Form from the CDC.
Coronavirus Disease (COVID-19) is a disease caused by the newly emerged coronavirus SARS-CoV-2. To prevent further spread of the virus and to better understand its impact on health outcomes, CDC has developed a form that provides a standardized approach to reporting COVID-19 cases (individuals with at least one respiratory specimen that tested positive for the virus that causes COVID-19). Collect data on demographic, clinical, and epidemiologic characteristics, exposure and contact history, course of illness and care received and more. This information is needed to track the impact of the outbreak and inform public health response.
Source: https://www.cdc.gov/coronavirus/2019-ncov/php/reporting-pui.html