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Influenza A H5 Domestic Case Screening Form Instructions Note This form is intended to screen initial report s of possible highly pathogenic avian influenza HPAI in humans especially those acquired by travel overseas.
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How to fill out influenza a h5 domestic
How to fill out Influenza A (H5) Domestic Case Screening Form
01
Obtain the Influenza A (H5) Domestic Case Screening Form from the appropriate health authority or website.
02
Fill in the patient's personal information, including name, age, gender, and contact details.
03
Provide information about the patient's symptoms, including onset date and duration.
04
Indicate any recent travel history, especially to areas with reported Influenza A (H5) cases.
05
List any potential exposure to infected individuals or environments.
06
Complete any additional sections related to medical history or relevant vaccinations.
07
Review the entire form for accuracy and completeness.
08
Submit the form to the designated health authority or facility.
Who needs Influenza A (H5) Domestic Case Screening Form?
01
Individuals showing symptoms of influenza or those who have been in contact with confirmed cases.
02
Travelers returning from areas affected by Influenza A (H5) outbreaks.
03
Healthcare providers assessing potential cases in their patients.
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What is Influenza A (H5) Domestic Case Screening Form?
The Influenza A (H5) Domestic Case Screening Form is a document used to collect necessary information regarding potential human cases of H5 influenza virus infection.
Who is required to file Influenza A (H5) Domestic Case Screening Form?
Individuals who exhibit symptoms of influenza and have a history of exposure to birds or areas affected by H5 influenza are typically required to file this form.
How to fill out Influenza A (H5) Domestic Case Screening Form?
To fill out the form, individuals must provide personal information, details of any symptoms experienced, travel history, and exposure to infected animals.
What is the purpose of Influenza A (H5) Domestic Case Screening Form?
The purpose of the form is to facilitate the identification and monitoring of potential H5 influenza cases to ensure proper public health responses.
What information must be reported on Influenza A (H5) Domestic Case Screening Form?
The form requires reporting personal information including name, age, contact details, symptoms, travel history, and any known exposure to infected birds or environments.
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