Get the free Pertussis Case Report Form - the Tennessee Department of Health - health state tn

Tennessee Department of Health Pertussis Case Report, Revised: 09/2010 Please fill out all three pages of this form as complete as possible. Anything that appears in red is not available for data

How to fill out pertussis case report form

How to fill out pertussis case report form:

1. Obtain the pertussis case report form from the appropriate healthcare agency or department. This form may be available online or in physical copy.
2. Start by providing the basic information of the person filling out the form, such as name, contact information, and job title.
3. Clearly identify the patient by entering their personal details, including name, date of birth, address, and contact information.
4. Provide the dates of onset of symptoms and diagnosis, as well as any relevant medical history related to pertussis or other relevant conditions.
5. Specify the healthcare provider's information, including their name, contact details, and facility.
6. Fill out the sections related to the confirmed or suspected pertussis case, documenting symptoms, laboratory test results, and treatment information.
7. Include any additional information required by the form, such as vaccination history or contact tracing.
8. Review the completed form for accuracy and ensure all necessary fields are filled correctly.
9. Sign and date the form to confirm the accuracy of the information provided.

Who needs pertussis case report form:

1. Healthcare professionals: Doctors, nurses, and other healthcare providers involved in diagnosing and treating pertussis cases need to fill out the pertussis case report form. This helps in tracking the spread of the disease and providing necessary public health measures.
2. Public health agencies: Local, state, and national public health agencies require the pertussis case report form to gather data on pertussis cases and take appropriate actions to prevent outbreaks.
3. Laboratories: Laboratories conducting pertussis tests need to fill out the pertussis case report form when reporting positive results. This allows public health agencies to track the number of confirmed cases accurately.

Note: The specific requirements for who needs the pertussis case report form may vary based on the jurisdiction and healthcare system in place. It is essential to consult with the relevant authorities to determine the necessary reporting procedures.

For pdfFiller’s FAQs

Can I create an eSignature for the pertussis case report form in Gmail?

It's easy to make your eSignature with pdfFiller, and then you can sign your pertussis case report form right from your Gmail inbox with the help of pdfFiller's add-on for Gmail. This is a very important point: You must sign up for an account so that you can save your signatures and signed documents.

How do I complete pertussis case report form on an iOS device?

Install the pdfFiller app on your iOS device to fill out papers. Create an account or log in if you already have one. After registering, upload your pertussis case report form. You may now use pdfFiller's advanced features like adding fillable fields and eSigning documents from any device, anywhere.

How do I edit pertussis case report form on an Android device?

The pdfFiller app for Android allows you to edit PDF files like pertussis case report form. Mobile document editing, signing, and sending. Install the app to ease document management anywhere.

What is pertussis case report form?

The pertussis case report form is a document used to collect information about cases of pertussis, also known as whooping cough. It is designed to gather details about the affected individual, their symptoms, medical history, and any potential contacts or sources of infection.

Who is required to file pertussis case report form?

Healthcare providers and laboratories are typically required to file the pertussis case report form. They are responsible for reporting any confirmed or suspected cases of pertussis to the relevant public health authorities.

How to fill out pertussis case report form?

To fill out the pertussis case report form, healthcare providers or laboratories need to provide accurate and detailed information about the affected individual's personal details, symptoms, medical history, and potential sources of infection. They may need to consult with the patient or review their medical records to gather all necessary information.

What is the purpose of pertussis case report form?

The purpose of the pertussis case report form is to collect standardized data about pertussis cases. This information is crucial for disease surveillance, outbreak investigations, and monitoring the impact of interventions. It helps public health authorities understand the disease patterns, identify trends, and develop appropriate control and prevention strategies.

What information must be reported on pertussis case report form?

The information that must be reported on the pertussis case report form may vary depending on the jurisdiction. However, common elements include the individual's personal details (name, age, sex), symptoms, laboratory test results, vaccination history, potential contacts, and any complications or hospitalizations related to pertussis.