National Notifiable Diseases Surveillance System (NNDCSS) [DEMO]

1. What is your name?

Name

2. What is your email address?

Email

3. What is your organisation?

Organisation

4. Reporting Health Professional Role

(Required) General Practitioner Infectious Disease Specialist Public Health Officer Laboratory Personnel Other:

If other, please describe.

5. State/Territory of Practice

Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia

Section 1: Reporter Information