The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

PvEF5kQL2goJAvWthcmSD7hhSSMNrTnt

Nebraska Foodborne Illness Report

Please complete this form if you wish to report a foodborne illness for yourself or on behalf of someone else in your household. We use this information to detect outbreaks of foodborne diseases. Generally, it takes about 5-10 minutes to fill out a complete report.

Privacy Information:

This report is completely voluntary.
All personal information will be kept confidential.
The appropriate state or local health department will be notified of your complaint and may initiate a facility inspection.
If an outbreak is identified, the state or local health department may follow up with you to collect more information.

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