Get the free cdc pertussis surveillance form

Pertussis Surveillance Worksheet Appendix 11 NAME (Last, First) Hospital Record No. Address (Street and No.) City County Zip Reporting Physician/Nurse/Hospital/Clinic/Payphone Address Phone DETACH

How to fill out cdc pertussis surveillance form

How to fill out cdc pertussis surveillance form:

1. Obtain the form from the CDC website or contact the CDC directly.
2. Carefully read the instructions provided with the form to understand the required information and any specific guidelines for completion.
3. Provide accurate and detailed information in each section of the form, such as demographic data of the patient, symptoms, vaccination history, and laboratory test results.
4. Follow any additional instructions for reporting the form, such as submitting it electronically or through mail.
5. Double-check the completed form for any errors or omissions before submitting it to the CDC.

Who needs cdc pertussis surveillance form:

1. Healthcare professionals: Doctors, nurses, and other healthcare providers who diagnose and treat patients with pertussis are required to report their cases to the CDC for surveillance purposes.
2. Laboratories: Clinical and diagnostic laboratories that conduct tests for pertussis should report positive results to the CDC to contribute to the overall monitoring and prevention efforts.
3. Public health agencies: Local, state, and federal public health agencies use the data collected on the surveillance form to assess the incidence and prevalence of pertussis in their respective populations and make informed decisions regarding prevention and intervention strategies.

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What is cdc pertussis surveillance form?

The CDC Pertussis Surveillance Form is a document used by healthcare providers to report cases of pertussis (also known as whooping cough) to the Centers for Disease Control and Prevention (CDC). It collects information about confirmed and suspected cases of pertussis in order to monitor and track the spread of the disease.

Who is required to file cdc pertussis surveillance form?

Healthcare providers, including doctors, nurses, and other medical professionals, are required to file the CDC Pertussis Surveillance Form for any cases of pertussis they encounter. This includes both suspected and confirmed cases of the disease.

How to fill out cdc pertussis surveillance form?

To fill out the CDC Pertussis Surveillance Form, healthcare providers must provide information about the patient, including their demographics, symptoms, diagnostic test results, and vaccination history. They must also include their own contact information and details about the healthcare facility where the patient was seen. The form can be filled out electronically or on paper and should be submitted to the appropriate local or state health department.

What is the purpose of cdc pertussis surveillance form?

The purpose of the CDC Pertussis Surveillance Form is to collect data on pertussis cases in order to monitor the disease, inform public health interventions, and assess the effectiveness of pertussis prevention strategies. The information collected helps the CDC and other public health agencies track the incidence and prevalence of pertussis, identify outbreaks, and develop strategies to control and prevent the spread of the disease.

What information must be reported on cdc pertussis surveillance form?

The CDC Pertussis Surveillance Form requires healthcare providers to report information such as patient demographics (age, sex, race, etc.), symptoms, vaccination status, diagnostic test results, and treatment details. Providers should also include their own contact information and information about the healthcare facility where the patient was seen. Additional information may be required depending on local or state reporting requirements.