编号姓名年龄性别职业家庭住址单位发病地点发病日期住院日期住院号发热咳嗽胸片或CTWBC 其他同类病例接触史或有传染性临床分型医院诊断报告日期收治单位是否上呼吸机核实诊断备注报告时间 :　　年　月　日　　　报告人 :　　　报告单位 (盖章 ) :非典型肺炎病例或疑似病例报 No. Name Sex Occupation Home Address Unit Place of onset Date of onset Date of hospitalization Hospitalized cough Chest radiograph or CTWBC Other similar cases of contact history or infectious clinical classification Hospital diagnosis report Date Receiving unit Whether on the ventilator Verification Diagnostic Remarks Report time: Year, Month, Day Reporter: Reporting Unit (Seal): SARS Case or Suspected Case Report