Get the free Lyme Borreliosis Surveillance Form - dshs state tx

Lyme Borreliosis Surveillance Form D E M O G R A P H I C S Last Name First Name MI () Patient s Phone Number Street Address City County Zip Age: Date of Birth: Race: White Black Asian Native American

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What is lyme borreliosis surveillance form?

The lyme borreliosis surveillance form is a document used to collect information about cases of lyme borreliosis, a tick-borne bacterial infection.

Who is required to file lyme borreliosis surveillance form?

Healthcare professionals, such as physicians, laboratories, and healthcare facilities, are required to file the lyme borreliosis surveillance form for diagnosed or suspected cases of lyme borreliosis.

How to fill out lyme borreliosis surveillance form?

The lyme borreliosis surveillance form typically requires information such as patient demographics, clinical symptoms, laboratory test results, and tick exposure history. Healthcare professionals can fill out the form manually or electronically, following the provided instructions.

What is the purpose of lyme borreliosis surveillance form?

The purpose of the lyme borreliosis surveillance form is to collect standardized data about cases of lyme borreliosis for public health surveillance. This helps in tracking the incidence and prevalence of the disease, understanding risk factors, and developing interventions to prevent and control lyme borreliosis.

What information must be reported on lyme borreliosis surveillance form?

The lyme borreliosis surveillance form typically requires information such as patient demographics, clinical symptoms, laboratory test results, tick exposure history, and treatment details. The exact data elements may vary based on the specific surveillance system.

When is the deadline to file lyme borreliosis surveillance form in 2023?

The deadline to file the lyme borreliosis surveillance form in 2023 may vary depending on the local or national reporting requirements. It is advisable to refer to the specific guidelines or contact the responsible public health agency for accurate deadlines.

What is the penalty for the late filing of lyme borreliosis surveillance form?

The penalty for the late filing of lyme borreliosis surveillance form may vary depending on the jurisdiction and reporting regulations. It is recommended to consult the local health authorities or relevant guidelines for information on penalties, if any, associated with late filing.

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