Get the free Varicella Case Investigation Form - cdc

This form is used for investigating cases of chickenpox (varicella) by collecting information about the patient's illness, medical history, and exposure.

How to fill out varicella case investigation form

How to fill out Varicella Case Investigation Form

1. Begin with the patient’s identification: Enter the patient's full name, date of birth, and contact information.
2. Record the date of illness onset: Indicate when the patient first showed symptoms.
3. Document vaccination history: Check if the patient has received the Varicella vaccine and when it was administered.
4. Include clinical information: Note the symptoms experienced by the patient, including the characteristic rash.
5. Fill in exposure history: Provide details about any known exposure to Varicella, including dates and contacts.
6. Answer questions on treatment: Describe any medical treatments the patient has received for Varicella.
7. Submit to local health department: Ensure all sections are completed and send the form to the appropriate health authority.

Who needs Varicella Case Investigation Form?

1. Individuals diagnosed with Varicella (chickenpox) who require public health monitoring.
2. Health care providers who need to report cases of Varicella.
3. Public health officials managing outbreaks and vaccination programs.

People Also Ask about

What is the diagnostic test for pox?

Key points. Mpox is diagnosed using real-time PCR tests. Tests are available through local, state, territorial or tribal health department and many large commercial laboratories. Clinicians should collect two swabs from each lesion in case additional testing, such as clade-specific testing, is needed.

What is the investigation of choice for chickenpox?

Most often, health care providers find out you have chickenpox based on the rash. Chickenpox also can be confirmed with lab tests, including blood tests or a tissue study of samples of affected skin.

How was chickenpox diagnosed?

Health care providers can usually diagnose chickenpox or shingles with a visual examination. But in some cases, your provider may also order a chickenpox or shingles test to confirm the diagnosis. These tests are also sometimes ordered to check for immunity to the varicella zoster virus (VZV).

What is the diagnostic test for chickenpox?

Polymerase chain reaction (PCR) PCR is the most useful laboratory test for confirming suspected varicella and zoster. PCR can detect VZV DNA rapidly and sensitively in skin lesions (vesicles, scabs, maculopapular lesions).

What are the investigations of varicella?

Polymerase chain reaction (PCR) PCR is the most useful laboratory test for confirming suspected varicella and zoster. PCR can detect VZV DNA rapidly and sensitively in skin lesions (vesicles, scabs, maculopapular lesions).

How do you document chicken pox?

“All histories of varicella illness must be supported by a written statement from a physician or the child's/student's parent or guardian containing wording such as: “This is to verify that (name of student) had varicella disease (chickenpox) on or about (month/day/year) and does not need varicella vaccine” or by

What are the clinical forms of varicella?

Chickenpox or varicella is a contagious disease caused by the varicella-zoster virus. The virus is responsible for chickenpox (usually primary infection in nonimmune hosts) and zoster or shingles (following reactivation of latent infection).

What are the diagnostic investigations of chickenpox?

What happens during chickenpox and shingles testing? You will need to provide a sample of blood from your vein or from the fluid in one of your blisters. Blood tests check for antibodies to the VZV. Blister tests check for the virus itself.

For pdfFiller’s FAQs

What is Varicella Case Investigation Form?

The Varicella Case Investigation Form is a standardized document used to collect and report detailed information about individual cases of chickenpox (varicella), which is essential for public health surveillance and outbreak management.

Who is required to file Varicella Case Investigation Form?

Health care providers who diagnose or treat a patient with varicella are required to file the Varicella Case Investigation Form to ensure proper tracking and reporting of the disease.

How to fill out Varicella Case Investigation Form?

To fill out the Varicella Case Investigation Form, follow these steps: provide patient identification information, describe clinical symptoms, document vaccination history, and include details about potential exposure and outcomes.

What is the purpose of Varicella Case Investigation Form?

The purpose of the Varicella Case Investigation Form is to gather comprehensive data that aids in monitoring varicella cases, facilitates public health response, and informs vaccination strategies to prevent outbreaks.

What information must be reported on Varicella Case Investigation Form?

The Varicella Case Investigation Form must include patient demographics, clinical presentation details, vaccination status, any known exposure history, laboratory test results, and the outcome of the case.