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Norvirus (Norwalk) Report

This form is intended for Mount Allison students who have symptoms of or a confirmed case of Norvirus (Norwalk) and are unable to report it to a Don.


Name :
Contact Phone #:
Residence :
MTA Email

ID #

Age

Gender	M F

Norwalk Diagnosed by a Physician?	Y N

Symptoms	Vomiting Diarrhea Fever

Pre-existing Condition	Y N