Get the free wv hepatitis cases form - dhhr wv

Hepatitis Case Investigation West Virginia Electronic Disease Surveillance System Division of Surveillance and Disease Control Infectious Disease Epidemiology Program Phone: 304-558-5358 or 800-423-1271

How to fill out wv hepatitis cases form

How to fill out the WV hepatitis cases form:

1. Start by gathering all the necessary information, such as the patient's personal details, medical history, and any lab results related to hepatitis.
2. Read the instructions provided with the form carefully to ensure you understand the required information and how to properly fill it out.
3. Begin by providing the patient's full name, date of birth, and contact information in the designated sections of the form.
4. Proceed to fill out the medical history section, including any previous hepatitis diagnosis, treatment, or vaccination records.
5. If available, attach any relevant lab reports or test results to support the hepatitis case.
6. Next, provide details about the current symptoms or complaints related to hepatitis.
7. Describe any known risk factors for hepatitis, such as exposure to contaminated blood, drug use, or recent travel to high-risk areas.
8. Answer any additional questions or sections specific to the WV hepatitis cases form.
9. Review the form to ensure all required fields are completed and there are no errors or missing information.
10. Lastly, sign and date the form to certify the accuracy of the provided information.

Who needs the WV hepatitis cases form:

1. Medical professionals or healthcare providers who have diagnosed a patient with hepatitis and are required to report the case to the State Health Department.
2. Individuals who have been diagnosed with hepatitis and are required to provide their medical information as part of the state's surveillance or tracking system.
3. Organizations or institutions responsible for monitoring and tracking cases of hepatitis to assess the prevalence and impact of the disease in the community.

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What is wv hepatitis cases form?

The wv hepatitis cases form is a document used to report cases of hepatitis in the state of West Virginia.

Who is required to file wv hepatitis cases form?

Healthcare providers, medical facilities, and laboratories in West Virginia are required to file the wv hepatitis cases form.

How to fill out wv hepatitis cases form?

The wv hepatitis cases form can be filled out electronically or manually. It requires information such as patient demographics, medical history, test results, and dates of diagnosis and treatment.

What is the purpose of wv hepatitis cases form?

The purpose of the wv hepatitis cases form is to collect data on hepatitis cases in West Virginia for public health surveillance and prevention efforts.

What information must be reported on wv hepatitis cases form?

The wv hepatitis cases form requires information such as patient demographics, medical history, test results, dates of diagnosis and treatment, and any known risk factors for hepatitis.