Suspect Pandemic Influenza Cases

Questions marked with an asterisk (*) are mandatory.

Contact Information Daily Tally of Suspect Pandemic Influenza Cases Admitted to Orange County Acute Healthcare Facilities.

1

* Name of facility (select from drop down menu): Anaheim General Hospital Anaheim Memorial Hospital Buena Park Doctors Hospital Chapman General Hospital Children's Hospital of Orange CHOC at Mission Coastal Community Hospital of Orange County College Hospital Costa Mesa Fairview Development Center Fountain Valley Regional Hospital Garden Grove Medical Center Hoag Memorial Hospital Presbyterian Huntington Beach Medical Center Kaiser Foundation Hospital Anaheim Kaiser/Irvine Medical Center Kindred Hospital Brea Kindred Hospital Westminster La Palma Intercommunity Hospital Los Alamitos Medical Center Mission Hospital Orange Coast Memorial Medical Center Placentia-Linda Community Hospital Saddleback Hospital and Health Center Saint Joseph Hospital Saint Jude Medical Center San Clemente Hospital Tustin Hospital & Medical Center Tustin Rehabilitation Hospital University of California Irvine Medical Center West Anaheim Medical Center Western Medical Center Anaheim Western Medical Center Santa Ana

2	* Your name / department:

3	* Your phone number: