PATIENT'S NAME: I. DEMOGRAPHIC AND ISOLATE INFORMATION CHOLERA AND OTHER VIBRIO ILLNESS SURVEILLANCE REPORT ADDRESS: PHYSICIAN'S NAME: TEL.: REPORTING HEALTH DEPARTMENT City: State Epi No.: State Lab Isolate ID:(38-49) FDA No.: 2. Date of birth: 3. Age: 4. Sex: (80) 5. Ethnicity: (81) 7. Occupation: 8..