KS KDHE Reportable Disease Form 2008 free printable template

KANSAS NOTIFIABLE DISEASE FORM Today s Date: / / Patient s Name: Last First Day Phone: Middle Evening Phone: Residential Address: City: Zip: Ethnicity: Race: Sex: Hispanic or Latino County: Not Hispanic

How to fill out KS KDHE Reportable Disease Form

How to fill out KS KDHE Reportable Disease Form

1. Obtain a copy of the KS KDHE Reportable Disease Form from the Kansas Department of Health and Environment website or your local health department.
2. Fill out the patient information section, including name, date of birth, address, and phone number.
3. Provide the healthcare provider's information, including name, facility, address, and contact details.
4. Specify the reportable disease by selecting it from the provided list or entering the name if it's not listed.
5. Include the date of diagnosis or identification of the disease.
6. Complete the exposure history if applicable, detailing any relevant travel, outbreaks, or contact with infected individuals.
7. Sign and date the form, certifying that the information provided is accurate to the best of your knowledge.
8. Submit the completed form to the appropriate health department via fax, secure email, or mail as instructed on the form.

Who needs KS KDHE Reportable Disease Form?

1. Healthcare providers who diagnose or treat reportable diseases.
2. Laboratories that test for reportable diseases.
3. Public health officials and organizations that require disease surveillance and monitoring data.
4. Entities involved in outbreak investigations.

People Also Ask about

What diseases are reportable to the CDC?

Nationally Notifiable Diseases Cholera. Cryptosporidiosis. Cyclosporiasis. Giardiasis. Hepatitis A. Legionellosis. Malaria* Salmonellosis.

What does it mean if a disease is reportable?

Notifiable disease. A disease that, when diagnosed, requires health providers (usually by law) to report to state or local public health officials. Notifiable diseases are of public interest by reason of their contagiousness, severity, or frequency.

What is the difference between reportable and notifiable diseases?

Reportable diseases are diseases that must be brought to the attention of ISDA immediately, as soon as identified. Notifiable diseases are diseases that must be brought to the attention of ISDA within 48 hours of discovery.

What makes a disease reportable?

A disease that, when diagnosed, requires health providers (usually by law) to report to state or local public health officials. Notifiable diseases are of public interest by reason of their contagiousness, severity, or frequency.

What are the reportable diseases in Kansas?

Suspected Act of Terrorism Anthrax. Botulism. Brucellosis. Plague. Tularemia. Q fever. Smallpox. Viral hemorrhagic fever.

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What is KS KDHE Reportable Disease Form?

The KS KDHE Reportable Disease Form is a standardized document used in Kansas to report cases of certain diseases and conditions that are required to be reported to the Kansas Department of Health and Environment (KDHE) for public health monitoring and response.

Who is required to file KS KDHE Reportable Disease Form?

Healthcare providers, laboratories, and other entities that diagnose or identify reportable diseases are required to file the KS KDHE Reportable Disease Form.

How to fill out KS KDHE Reportable Disease Form?

To fill out the KS KDHE Reportable Disease Form, one must provide patient information such as name, address, date of birth, the disease being reported, date of diagnosis, and any pertinent clinical information or laboratory results as required by the form.

What is the purpose of KS KDHE Reportable Disease Form?

The purpose of the KS KDHE Reportable Disease Form is to facilitate the collection of data regarding communicable and non-communicable diseases, which helps in monitoring and controlling outbreaks, protecting public health, and informing epidemiological investigations.

What information must be reported on KS KDHE Reportable Disease Form?

The information that must be reported includes the patient's identifying information (name, address, date of birth), the specific disease or condition, the date of diagnosis, laboratory results, and any relevant clinical details related to the case.