Get the free Monkeypox Contact Surveillance Form - dhhr wv

El objetivo de este formulario es proporcionar un registro para el departamento de salud estatal/local y una hoja de trabajo/diario para los contactos de casos de viruela símica (humanos o animales),

How to fill out monkeypox contact surveillance form

How to fill out Monkeypox Contact Surveillance Form

1. Gather personal information, including name, date of birth, and contact details.
2. Provide information about recent exposure to a confirmed case of monkeypox.
3. List any symptoms experienced since exposure, including date of onset.
4. Include vaccination status for smallpox or monkeypox, if applicable.
5. Sign and date the form to attest that the information is accurate.

Who needs Monkeypox Contact Surveillance Form?

1. Individuals who have been in close contact with a confirmed monkeypox case.
2. Healthcare providers monitoring potential monkeypox exposure.
3. Public health officials tracking and managing monkeypox outbreaks.

People Also Ask about

What are mpox disease symptoms?

Mpox symptoms tend to start within 21 days after you come in contact with the virus. You may have symptoms that are like the flu, including a sore throat, runny or stuffy nose, and a cough. Other symptoms may include: Swollen lymph nodes.

What to do if you come in contact with someone with monkeypox?

If you know you've been exposed to someone with mpox, contact your local public health authority immediately. Your local public health authority may also tell you that you've been exposed to someone with mpox.

Is mpox life threatening?

Can you survive mpox? Clade II mpox — the subtype causing a global outbreak — is rarely fatal. The fatality (death) rate for clade I has historically been around 10%. But during recent outbreaks, it's been less than 3.3%.

What are the contact precautions for monkeypox?

Limit exposure to others Avoid contact with unaffected individuals until the rash has resolved, the scabs have fallen off, and a fresh layer of intact skin has formed. Isolate in a room or area separate from other household members and pets when possible.

What is the portal of entry for monkeypox?

The portal of entry of the Monkeypox virus includes mucus membranes such as the nose, mouth, and eyes, respiratory and abrasion.

Why is it called mpox now?

Avoid direct or skin-to-skin contact with people who have a rash that looks like mpox. Don't use objects or materials a person with mpox has used. Avoid wild animals in areas where mpox occurs regularly. Wash hands often and learn steps to lower your risk of mpox during sex or at social gatherings.

What is mpox pdf?

Mpox (previously named monkeypox) is caused by infection with monkeypox virus, a member of the genus Orthopoxvirus in the family Poxviridae. There are currently more than 80 poxviruses known to science and these poxviruses have been isolated from different species of birds, insects, reptiles, marsupials and mammals.

For pdfFiller’s FAQs

What is Monkeypox Contact Surveillance Form?

The Monkeypox Contact Surveillance Form is a document used to collect and report information on individuals who have been identified as contacts of confirmed monkeypox cases, to monitor and manage potential transmission of the virus.

Who is required to file Monkeypox Contact Surveillance Form?

Healthcare providers and public health officials are required to file the Monkeypox Contact Surveillance Form for individuals who have been in close contact with confirmed monkeypox cases.

How to fill out Monkeypox Contact Surveillance Form?

To fill out the Monkeypox Contact Surveillance Form, you need to provide information such as the contact's personal details, the date of exposure, symptoms observed, and any preventive measures taken.

What is the purpose of Monkeypox Contact Surveillance Form?

The purpose of the Monkeypox Contact Surveillance Form is to facilitate tracking of individuals who may have been exposed to monkeypox, enabling timely intervention, monitoring for symptoms, and reducing the risk of further transmission.

What information must be reported on Monkeypox Contact Surveillance Form?

The information that must be reported includes the contact's name, contact details, date of exposure, relationship to the confirmed case, vaccination history, and any symptoms they are experiencing or have experienced.