Get the free Form 2E Smallpox Case Household and Primary Contact Surveillance Form - dhhr wv

Form 2E: Smallpox Case Household and Primary Contact Surveillance Form Please print I. CASE INFORMATION (Filled out by interviewer) 1. *CASE ID#: OMB NO. 0920-0008 Exp. Date: 06/2003 II. HOUSEHOLD

How to fill out form 2e smallpox case

How to fill out form 2e smallpox case:

1. Begin by entering the necessary demographic information, such as the individual's name, date of birth, and contact details.
2. Provide information about the suspected smallpox case, including the date of onset of symptoms and the location where the individual was initially seen.
3. Describe the symptoms and clinical findings observed in the individual, ensuring to include any relevant medical history or underlying conditions.
4. Specify the laboratory tests conducted to confirm the smallpox diagnosis, along with the results obtained.
5. Document the individual's vaccination history, indicating whether they have previously received the smallpox vaccine.
6. Include information about the individual's isolation and treatment, including any medications administered or procedures performed.
7. Record any contacts the individual has had during their infectious period and provide details on any contact investigations or management measures taken.
8. Finally, sign and date the form to validate the information provided.

Who needs form 2e smallpox case:

1. Public health authorities and medical professionals involved in the diagnosis, treatment, and control of smallpox cases require form 2e smallpox case.
2. Healthcare facilities, laboratories, and institutions responsible for reporting and monitoring infectious diseases, particularly including smallpox, should utilize this form.
3. This form may also be required by national or international health agencies for disease surveillance and response purposes.

For pdfFiller’s FAQs

What is form 2e smallpox case?

Form 2e smallpox case is a specific document used to report smallpox cases to the relevant authorities.

Who is required to file form 2e smallpox case?

Healthcare professionals, such as doctors or medical facilities, are required to file form 2e smallpox case when they encounter a smallpox case.

How to fill out form 2e smallpox case?

Form 2e smallpox case can usually be filled out online through a secure submission portal. The specific instructions and required information can vary depending on the jurisdiction.

What is the purpose of form 2e smallpox case?

The purpose of form 2e smallpox case is to facilitate the timely reporting of smallpox cases for public health monitoring and surveillance purposes.

What information must be reported on form 2e smallpox case?

The specific information required to be reported on form 2e smallpox case can vary, but generally includes details about the patient's demographic information, symptoms, diagnosis, and any relevant travel history.

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