Ebola Monitoring Tutorial November 2014

Ebola Monitoring Tutorial November 2014 The New Jersey Department of Health Communicable Disease Service (NJDOH CDS) staff will review DGMQ Ebola airport screening notifications posted on EpiX. For any persons living and/or staying in their jurisdiction, an Ebola report will be created in the secure, online Communicable Disease Reporting and Surveillance System (CDRSS) by NJDOH CDS staff. The report will include contact information for the person and will appear as a Report Under Investigation (RUI) on the Pending screen of the local health department (LHD) where the person resides or is staying in New Jersey. Please note that cases in CDRSS (unless otherwise indicated) reflect a person monitoring for symptoms, NOT a report of acute infection. This tutorial walks you through the CDRSS functions that will help you monitor your cases and document your information as outlined in the LINCS notification: New Jersey Department of Health, Communicable Disease Service Recommendations for Follow-Up of Ebola Virus Disease (EVD) Low (but not zero) Exposure Reported from the CDC Division of Global Migration and Quarantine (DGMQ). A mock up Test case was entered into the CDRSS Production site at https://cdrs.doh.state.nj.us and was used for the screen shots taken for this tutorial. There are four sections to this tutorial: Section One: Accessing and Updating Information in an Existing Ebola Monitoring Case (page 2) Section Two: Updating DOH Regarding Monitoring Information (page 21) Section Three: Finding Your Ebola Monitoring Cases with the Advanced Search and Saving That Search to Utilize in the Future (page 23) Section Four: Setting Up New or Updating Existing Automatic E-mail Notifications for New Ebola Monitoring Cases (page 29) CONTACT INFORMATION: NJDOH CDS Staff: 609-826-5964 (regular business hours) 609-392-2020 (after hours, weekends and holidays) CDRSS Helpdesk: 609-826-4749 or CDRSADMIN@doh.state.nj.us CDRSTRAIN@doh.state.nj.us for CDRSS training and access information [NOTE: You must be trained and sign a user agreement before gaining access to the CDRSS.] R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 1

SECTION ONE: Accessing and Updating Information in an Existing Ebola Monitoring Case The New Jersey Department of Health Communicable Disease Service (NJDOH CDS) staff will create an Ebola report in the CDRSS for each person identified as living/staying within New Jersey s jurisdiction. The report will include contact information for the person to be monitored and will appear as a Report Under Investigation (RUI) on the Pending screen of the local health department (LHD) whose jurisdiction includes the primary address where the person to be monitored resides or is currently staying in New Jersey during this monitoring period. Local health department CDRSS users will see their Pending cases when they log in to CDRSS. The diseases are listed in reverse chronological order, with the most recent case at the top of the list, with 25 cases displayed on each screen. Clicking on the Disease column heading Disease will put the cases into ascending alphabetical order by disease name (A-Z), which will bring all the Ebola cases together. Users can scroll through the Pending Cases screens, if they have more than 25 Pending cases, by clicking on the Next arrow screen, until they get to the Ebola cases. at the top of the To access a case, click on the Disease name EBOLA in the Disease column for the correct patient last and first name. Click on disease name for correct patient s name to access case R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 2

That will take the user into the ten tabs of that case, starting on the Patient Info Tab. The tab you are currently on in the case is bolded to stand out from the other tabs. Tab One: Patient Info NJDOH will have entered the personal contact information on this tab. If the LHD acquires more patient information, such as an e-mail address, or extra or corrected phone numbers to replace incorrect existing ones, they should enter the information on the Patient tab in the appropriate text fields (see oval below). R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 3

NOTE: Address information for the primary residence when it is different from the monitoring address should be entered on the Address tab, not corrected on the Patient Address tab because the LHD will lose access to the case if the primary address is outside their viewing privileges. If the primary address must be changed, make sure the LHD adds their address on the Address tab to continue to have access to the case. The following examples indicate comments that should be entered in the Add Patient Info Comment: box at the bottom of the Patient Info tab: Individual Identified by DGMQ on Flight from Liberia. Emergency contact is Konah Collins and # 201-417-9108 To be under active monitor until 11/21/2014. NOTE: The quickest way to get to a specific tab within a case in the CDRSS is to scroll up to the top of the page and click on the appropriate tab name. Tab Two: Addresses 1. If the address on the Patient Info Tab is only where the person is residing in New Jersey for this monitoring event (it is not the real primary residence of the person being monitored) and the LHD has the primary address - they can enter it on the Address tab ONLY IF THEY HAVE SPOKEN TO NJDOH CDS STAFF FIRST FOR AUTHORIZATION TO DO SO by doing the following: a. Click on the Address tab to get to the Address tab b. Click on the Address Type dropdown arrow Click on dropdown arrow R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 4

c. Select Other Address on the Address Type dropdown Select Other Address from Address Type dropdown d. Click on the ADD NEW next to the Address Type dropdown Click on ADD NEW e. Enter the new information in the resulting pop-up screen Enter Primary address and contact information [NOTE: you can select other states from the State dropdown] and click Continue R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 5

f. And put a notation in the Add Address Comments field that this Other Address is the person s primary one Primary address in Washington DC added. Tab Three: Clinical Status 1. This tab is currently not used for the Ebola Monitoring cases. Tab Four: Signs and Symptoms 1. Signs and Symptoms typical for the disease being investigated are automatically listed on the Signs and Symptoms tab when the disease is selected when the case is created. List of Symptoms R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 6

2. For cases requiring monitoring, the LHD must enter the patient-reported readings for fever 2 times per day for 21 days. a. Check the checkbox next to Fever and enter the temperature in the Attribute text field next to Fever (enter only one temperature per Attribute text field). Check box for fever and add temperature in Attribute field b. Then enter the Date and Time in only the top box of the two boxes in the Onset/Resolution Date column next to the Attribute field where you recorded the temperature for that entry. To enter the date, you must first click on the top blank box to generate the calendar pop-up that also shows a time in the bottom section of the pop-up. Note that the calendar defaults to today s date and 12:00 am as the time. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 7

c. Click on the appropriate date and change the time to the correct hour/minute and AM or PM of the reading submitted by the patient. Click on the correct date for the reading being recorded Select the correct hour and minutes and AM or PM for this reading d. NOTE: clicking on the date selected loads the time and date you chose on the pop-up into the Onset/Resolution Date field. A Clear button appears next to the time and date you entered. This allows you to remove your entry if it is incorrect. Date and time entered Click Clear to remove current entry if incorrect NOTE: The Fever monitoring will require 42 separate Fever temperature entries, 2 for each day, for 21 days, each one date and time stamped appropriately. 3. Each of the monitoring temperatures needs to be recorded under a separate Fever entry so you will need to add another Fever checkbox to the Signs and Symptoms tab for each record. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 8

a. You can add another Fever checkbox by clicking on the Add Symptom Not Listed Above button b. Which generates a pop-up where you can then select Fever from the dropdown Select Fever R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 9

c. And then click on Continue to add it to the Signs/Symptoms tab. d. You now have a new blank Fever under the one you previously entered. A new Fever e. The box next to the new Fever is already checked. Enter the next monitoring temperature in the new Fever Attribute text field and enter the date and time in Onset/Resolution Date text field on same line as the new fever just recorded. You now have 2 Fever recordings. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 10

4. Check off any other symptoms and enter their Attribute as appropriate and date and time stamp each entry if that information is available. Tab Five: Risk Factors 1. This tab is currently not used for the Ebola Monitoring cases. All monitoring cases have been identified due to travel to a high risk area, so that risk factor is considered the default for all of these cases, so it is not re-recorded here. Tab Six: Laboratory Eval 1. This tab is currently not used for the Ebola Monitoring cases. Tab Seven: Contact Tracing 1. This tab is not used for all contacts of the person being monitored. It is only used if one person in the party traveling with the person being monitored was not documented at the time of initial identification, such as a parent traveling with three children who were documented, but also with an infant, who was not documented. A case would be created by DOH using the Contact Tracing tab to generate a new Ebola monitoring case in the CDRSS because it carries forward the appropriate name and address information into the new Ebola Monitoring case for the new person without having to create a new case from scratch. Tab Eight: Case Comments All comments are date and time stamped and referenced to the user who entered the comment when the case is submitted to the database when the user clicks on Submit. Each comment is assigned a Comment ID number. NOTE: Comments cannot be removed from a case once the case has been submitted. If a comment has been entered in error, add another comment referencing the Comment ID number and stating what the error was (for example, Comment ID 1424404: Comment entered in error in this case - refers to case ID number 680981. Please ignore. ) 1. LHD should document all attempts to contact the person to be monitored. 2. LHD should also document successful contact with person and monitoring notes. 3. LHD should document any information gathered in addition to initial survey information or that replaces erroneous information (such as The current phone number does not work, correct number is 123-456-7890 ). 4. To document comments on the Case Comments tab R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 11

a. Type comments in the Add General Comment: box at the bottom of the Case Comments tab Type comment b. When you have completed your comment and your data entry in the case, click on Submit. When you re-enter the case, you will see your comment on the Comments tab with your contact information in bold and the Comment ID as well as your message. Your entered comment c. If you entered the comment in error, type your comment error message in the Add General Comment box and click on Submit. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 12

d. Your correction message will become part of the Case Comments history. NOTE: Any comment entered in the comment box at the bottom of any of the 10 tabs in a case will be automatically copied to the Case Comments tab and the Comment Type column will indicate on which tab the comment was originally entered, for example, Address; Patient Info; Case Epidemiology. General indicates comments entered on the Case Comments tab; Case Summary on the Case Classification tab. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 13

Tab Nine: Epidemiology The LHD should conduct the following: 1. Re-evaluate potential exposure by conducting a risk assessment. While persons are given this risk assessment during enhanced airport screening, additional evaluation by the LHD is recommended. The risk assessment tool can be accessed in CDRSS on the Epidemiology tab (see instructions below). 2. At the bottom of the Outbreak/Investigation Information: section (just before the Risk Factors: section) there will be the following bold black font heading, Associated Questionnaire: EVD RISK MONITORING, followed on the next line by the blue ADD/MODIFY QUESTIONNAIRE RESPONSE heading. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 14

3. Click on the blue ADD/MODIFY QUESTIONNAIRE RESPONSE to access the survey. 4. You will get the following 3 page EVD RISK MONITORING survey from HIPPOCRATES. You can print the survey by clicking on the print icon in the upper right hand corner Click on Print icon R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 15

and then clicking on the Print button on the PRINT pop-up Click on Print button 5. Repeat the risk assessment with the person being monitored and record any changes in information on the survey and submit the survey after completing the Evaluator name and title section at the bottom of the survey. Update any information on any corresponding tabs in CDRSS, for example the Comments tab or the Signs and Symptoms tab. 6. Also enter any changes to the Risk Factors listed on the Epi tab by selecting the dropdown next to the appropriate item and choosing the appropriate response. For example, if the contact information was incorrect, click on the CONTACT INFORMATION INCORRECT dropdown and select Yes... NOTE: The -1 in the dropdown just means no selection has been made yet. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 16

7. Then in the Add Case Epidemiology Comment section at the bottom of the Epi tab, type Contact information for phone number incorrect. Not known at that number. 8. Another comment that should be entered on the Epidemiology tab is LAST DATE OF OBLIGATION TO REPORT: 11/18/14 which had already been entered in this test case. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 17

ATTENTION REGARDING REPEATING THE SURVEY WITH THE PERSON BEING MONITORED: NOTE 1: If the person answers no to all questions, they are considered to be low exposure other than travel and the LHD should proceed with the Traveler Responsibility and LHD Responsibility sections [as outlined in the October 23, 2014 LINCS Message re Active Post- Arrival Monitoring for Travelers from Impacted Countries, which included the NJDOH CDS Recommendations for Follow-Up of Ebola Virus Disease (EVD) Low Exposure* Reported from the CDC Division of Global Migration and Quarantine (DGMQ)] and document them in the CDRSS Ebola Monitoring Case under the 10 tabs as described above. NOTE 2: If the person answers yes to an exposure, the LHD should contact the NJDOH CDS and ask to speak with the regional epidemiologist for more guidance. Case Classification Tab Changing Case and Report Statuses of Ebola Monitoring Cases a. The initial Ebola report will be created by NJDOH in the CDRSS with a Case Status of Report Under Investigation (RUI) and a Report Status of Pending on the Case Classification tab and will appear on the Pending Cases screen of the local health department (LHD) within which jurisdiction the person resides. Case Status of RUI & Report Status of PENDING R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 18

b. Once initial contact has been made, the LHD will change the Report Status in CDRSS from Pending to LHD Open to serve as confirmation that verbal contact has been made and instructions have been provided to the person being monitored. Click on the Report Status dropdown c. Select LHD Open d. And continue with monitoring documentation until the 21 day monitoring period is completed. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 19

NOTE 1: Make a minimum of three (3) phone attempts to reach the person. If the person cannot be reached by phone or email, the LHD should contact the NJDOH CDS and ask to speak with the regional epidemiologist for more guidance. e. If the person shows no symptoms after 21 days, the LHD should close the report in CDRSS by assigning a case status of Not a Case and a report status of LHD Closed and put a comment in the Add Case Summary Comment: box that The temperature monitoring was completed on 11/11/14 night. Pt stated that has no symptoms as of today. NOTE 2: If the individual does develop symptoms LHD should IMMEDIATELY contact NJDOH CDS at 609-826-5964 during regular business hours and 609-392-2020 after hours, weekends and holidays for more guidance. ATTENTION RE SAVING YOUR INFORMATION IN THE CASE YOU ARE UPDATING: When adding information to an existing case in the CDRSS, the information is not saved to the database until the case is submitted you must hit the SUBMIT button at the bottom of any tab in CDRSS to submit the information to the database. You can enter data on multiple tabs within a case in the CDRSS but once you have completed your data entry, or a subset of your data entry, you must hit SUBMIT to save the information you entered. When entering a lot of data, it is wise to submit the data in smaller increments to ensure you do not time out (within approximately 45-60 minutes) and lose the data you have entered. Once you click on SUBMIT, you will have to go back into the case you are updating in order to enter more information to it. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 20

SECTION TWO: Updating DOH regarding monitoring information All cases will be created by DOH staff. The name of the specific person who created the case will appear at Created By: at the top of any tab in the Case in CDRSS just under the disease name. By clicking on the Created By name, you can generate a pop-up to send an e-mail directly to that person. The pop-up automatically copies you, lists the case ID number and disease name. You can copy whoever else needs to be included in the communication by adding their e- mail address to the CC or BCC lines, separating multiple addresses with a semi-colon between them. See Box A in screen shot below. You can also respond to any comment in the case by clicking on the author s name which will again take you to an e-mail pop-up that references the specific comment you are following up on. See Box B in screen shot below. Box A: To communicate with the NJDOH case creator, click on user name next to Created By at top of any tab within the case to generate an e-mail pop-up addressed to that user Box B: To communicate with the comment s author, click on the user name above the Comment ID you want to reference to generate an e-mail pop-up addressed to that user R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 21

When you click on the user name, you get a pop-up email and can enter text and other e-mail recipient addresses as appropriate (remember to separate multiple addresses with a semicolon between them). Note: Each user must maintain a current e-mail address in their User Profile, under Personalize on the left nav bar in the CDRSS to be able to send and receive e- mails via CDRSS. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 22

SECTION THREE: Finding Your Ebola Monitoring Cases with the Advanced Search and Saving That Search to Utilize in the Future Part 1: HOW TO FIND THE ADVANCED SEARCH SCREEN You can access the Advanced Search one of two ways: 1) From the Advanced Tab: a. Click on the Advanced tab on the Pending Cases screen when you login to CDRSS Patient identifiers are hidden for confidentiality in these screen shots b. Which takes you to the Advanced Search screen R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 23

OR 2) Go to the left navigation(nav) bar, a. Click on Search, Search b. Then click on the Advanced search under Case Search Advanced c. Which takes you to the Advanced Search screen R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 24

Part 2: SETTING THE ADVANCED SEARCH PARAMETERS TO FIND EBOLA MONITORING CASES WITHIN YOUR JURISDICTION TO MONITOR 1) On the Advanced Search Screen: a. Select Ebola from the Disease selection box b. In the Case Status box select Report Under Investigation and c. In the Report Status box select Pending [NOTE: You can include other case and/or report statuses as required.] d. Hit Submit EBOLA RUI PENDING SUBMIT 2) You will get the search screen with a list of Ebola cases, each with a Case Status of RUI and a Report Status of Pending within your jurisdiction at the time you ran the report, if there are any. On that screen there is a Save this Search button which lets you save the search you just initiated. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 25

3) When you click on the Save this Search button, you generate a pop-up prompt to name the search. Type in a search name of your choosing (we used Ebola RUI Pending cases for MY LHD ) and click OK. 4) You get a pop-up telling you that Ebola RUI Pending cases for MY LHD has been added to your Saved Searches. Click OK to save it this search. 5) You will now have a new tab called Saved Searches on the login screen: R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 26

6) The next time you login to CDRSS, the search you just executed, named and saved will be an option on your Saved Searches tab dropdown on your Pending cases login screen. a. Click on the Saved Searches tab to access the dropdown for your saved searches and select the search name to regenerate that specific search. b. NOTE: The search will be run on the disease(es) you selected, for the case and report status(es) you selected, but will reflect the data per the new time and day that you rerun the report. The data from previous searches is not stored; only the search parameters are stored under the specific saved search name. Rerunning this search on a different day and time yielded 2 different cases, instead of the 4 original cases found on the initial run, because only those 2 cases matched the search criteria at the time the report was rerun. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 27

c. The Search name for the search run is indicated on the search results screen and there is a button to Delete This Search that enables you to delete that specific search from your saved searches, if/when appropriate (see rectangle below). You also have the option to update the search from this screen to change the search parameters (see oval below). All search deletions and changes are updated once you logout and log back into CDRSS. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 28

SECTION FOUR: Setting Up New or Updating Existing Automatic E-mail Notifications for New Ebola Monitoring Cases ADDING/UPDATING EMAIL NOTIFICATIONS FROM USER PROFILE PART ONE: To set up a new e-mail notification: 1. Go to Personalize on the left nav bar, click on Personalize and then click on Email Notifications. Defaults to New versus Edit Existing radio button. 2. For the Email Notifiation: a. Enter name of Email Notification, for example, Ebola New Monitoring Case Notification. b. Select the disease(s) you want e-mail notifications for in the Available box, then click on the Select between the Available and the Selected boxes to move the selected disease(s) to the Selected box. c. Enter e-mail addresses of desired recipients (they do not have to be CDRSS users to receive the notification e-mails of the existence of a case, but they will not be able to access the case in the CDRSS if they are not). d. Select the radio button for the type of notification (New Case or Change of Case Status) and then e. Select the appropriate Case Statuses from the active selection box below Type of Notification selected f. Hit Submit R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 29

a. Name e-mail notification b. Click on disease(s) and then click on Select to move disease to Selected box d. Choose Notification Type c. Enter email address(es); separate by semi colon if more than one e. Choose Case Status(es) f. Then Submit 3. The e-mail notification looks like this; note it does not have any identifiers in it so it can be shared with non-cdrss users at the local health department. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 30

PART TWO: To change an existing e-mail notification: If you already have e-mail notifications set up, you can to add a new notification or edit an existing notification: 4. Choose Edit Existing radio button and select name from dropdown if have multiple options, otherwise defaults to your last name: 5. Click on Get Data to see parameters currently set up for Email Notifications: R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 31

6. To change notification: a. Select disease(s) you want e-mail notifications for from Available box, click on Select between the Available and the Selected boxes to move the selected disease(s) to the Selected box. [NOTE: you can also select diseases in the bottom Selected box and click on the De-Select between that and the Available box to move the diseases you do not want notifications for back to the Available box.] b. Enter e-mail addresses of desired recipients (they do not have to be CDRSS users to receive the notification e-mails) and c. Select the radio button for the Type of Notification (New Case or Change of Case Status) and d. Select the appropriate Case Statuses from the active selection box below your Type of Notification selected. e. Then click on Submit. a. Click on disease(s) in upper box and then click on Select to move disease to lower box b. Enter e-mail address, if multiple, separate by semicolon between addresses c. Choose notification type d. Choose Case Status(es) e. Then Submit NOTE: If you want to inactivate an existing notification, you can check the Inactive checkbox just above the Submit button to inactivate the whole notification (see the red circle in the screen shot above). You can also leave the notification active but just change the diseases and notification types of some of your selection, as needed, as outlined in items a-e above. R:\TRAINING\MARLENE TRAININGS\2014 CDRSS Pilot training docs\ebola Monitoring in CDRSS Tutorial Nov 2014.docx 32