Typhoid Ulcer Clinical Case Report Form
Please complete the following details to document a typhoid ulcer clinical case. All information should be accurate and concise.
Report Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Patient Age
*
Patient Gender
*
Male
Female
Other
Presenting Symptoms
*
Fever
Abdominal pain
Gastrointestinal bleeding
Perforation
Other
Ulcer Location
*
Please Select
Ileum
Colon
Other
Ulcer Characteristics
Diagnostic Method
*
Please Select
Clinical diagnosis
Endoscopy
Surgical findings
Other
Treatment Provided
Outcome
*
Please Select
Recovered
Improved
Unchanged
Deceased
Clinician Name and Contact
*
Submit Case Report
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