Get the free Enteric Illness Complaint Form - dphhs mt

A form used to collect information regarding complaints of enteric illnesses, including details about the complainant, symptoms, clinical visits, and suspect meals.

How to fill out enteric illness complaint form

How to fill out Enteric Illness Complaint Form

1. Begin by downloading the Enteric Illness Complaint Form from the appropriate health department website.
2. Fill in your personal information, including your name, address, phone number, and email address.
3. Describe the nature of your illness, including symptoms and onset date.
4. Provide details about any recent food or water consumption, including names of restaurants or brands if applicable.
5. Include information about any medical treatment received, such as doctor visits or hospitalizations.
6. If available, attach any relevant documents such as medical records or receipts.
7. Review the completed form for accuracy and completeness.
8. Submit the form according to the instructions provided, either via email, online submission, or mailing it to the designated health department.

Who needs Enteric Illness Complaint Form?

1. Individuals who suspect they have contracted an enteric illness from contaminated food or water.
2. Healthcare providers who are reporting cases on behalf of patients.
3. Public health officials collecting data on outbreaks or trends in enteric illnesses.

For pdfFiller’s FAQs

What is Enteric Illness Complaint Form?

The Enteric Illness Complaint Form is a document used to report cases of gastrointestinal illnesses, such as foodborne diseases, to public health authorities.

Who is required to file Enteric Illness Complaint Form?

Individuals who experience symptoms of enteric illness or those who suspect that they have contracted a foodborne illness are typically required to file the Enteric Illness Complaint Form.

How to fill out Enteric Illness Complaint Form?

To fill out the Enteric Illness Complaint Form, provide personal information such as your name and contact details, specifics of your illness, symptoms experienced, and any suspected food sources involved.

What is the purpose of Enteric Illness Complaint Form?

The purpose of the Enteric Illness Complaint Form is to collect data on gastrointestinal illnesses to help public health officials identify potential outbreaks and take necessary actions to prevent further cases.

What information must be reported on Enteric Illness Complaint Form?

The information that must be reported includes the person's contact information, symptoms, duration of illness, date of onset, suspected foods consumed, and any medical treatment received.