Get the free Zika Requisition Form - Washington State Department of Health - doh wa

State of Washington Department of Healthier PHL USE NONPUBLIC HEALTH LABORATORIES 1610 N.E. 150th Street Lab NumberShoreline, Washington 981559701 Phone: (206) 4185400 Fax: (206) 3640072 Mandate/Time

How to fill out zika requisition form

How to fill out a Zika requisition form:

1. Start by identifying the main purpose of the form. Understand that a Zika requisition form is typically used to request testing for the Zika virus.
2. Gather the necessary information. You will need to provide personal details such as your name, date of birth, and contact information. Be prepared to also provide information about your medical history and any potential exposure to Zika virus.
3. Fill out the patient information section. This section will typically require you to enter information such as your gender, race/ethnicity, and gestational status (if applicable). It is important to provide accurate and up-to-date information to ensure proper evaluation and testing.
4. Indicate the reason for the request. Specify why you are seeking a Zika virus test. Common reasons may include symptoms of Zika infection, recent travel to a Zika-endemic area, or potential exposure through sexual contact or blood transfusion.
5. Complete the healthcare provider section. This section typically requires the name, address, and contact information of the healthcare provider requesting the test. If you are filling out the form on behalf of someone else, ensure that you accurately provide their healthcare provider's information.
6. Provide relevant medical history. You may be asked to disclose information about any recent illnesses, known allergies, or medications you are currently taking. This information helps healthcare professionals in evaluating your overall health and determining the appropriateness of Zika testing.
7. Sign and date the form. Confirm that all the necessary information has been provided accurately and legibly. Put your signature and the date to validate the form.

Who needs a Zika requisition form:

1. Individuals experiencing symptoms: Anyone who is experiencing symptoms such as fever, rash, joint pain, or red eyes and suspects possible Zika infection should request a Zika test by filling out a requisition form.
2. Travelers to Zika-endemic areas: Those who have recently traveled to regions with ongoing Zika virus transmission may require a Zika test upon return, depending on the guidelines provided by health authorities.
3. Pregnant individuals: Pregnant individuals, especially those who have traveled to or reside in Zika-endemic areas, may need to fill out a requisition form for Zika testing. This is crucial as Zika infection during pregnancy can lead to severe birth defects, including microcephaly.
4. Individuals with potential exposure: Those who have had unprotected sexual contact with a person infected with Zika or have received a blood transfusion may need to request a Zika test by completing a requisition form. Identifying potential exposure helps healthcare professionals assess the risk and provide appropriate recommendations.

It is important to note that the specific requirements for a Zika requisition form may vary depending on the jurisdiction and healthcare facility. Always follow the instructions provided on the form or consult with your healthcare provider for guidance.

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What is zika requisition form?

The zika requisition form is a document used to request testing for the zika virus.

Who is required to file zika requisition form?

Healthcare providers and laboratories are required to file the zika requisition form.

How to fill out zika requisition form?

The zika requisition form should be completed with patient information, relevant medical history, and reason for testing.

What is the purpose of zika requisition form?

The purpose of the zika requisition form is to facilitate testing for the zika virus and track potential outbreaks.

What information must be reported on zika requisition form?

Information such as patient demographics, symptoms, travel history, and date of onset should be reported on the zika requisition form.