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This form is used to report the details of a newborn infant born to a mother who is Hepatitis B surface antigen (HBsAg) positive, including case information, medication administered, and birth statistics.
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How to fill out montana perinatal hepatitis b
How to fill out Montana Perinatal Hepatitis B Prevention Program Hospital/Birth Facility Report Form
01
Obtain the Montana Perinatal Hepatitis B Prevention Program Hospital/Birth Facility Report Form from the appropriate health department or online.
02
Fill in the facility name, address, and contact information at the top of the form.
03
Enter the patient's name, date of birth, and medical record number.
04
Indicate the mother's name and any relevant medical history regarding Hepatitis B.
05
Provide details about the infant, including time of birth, weight, and any complications.
06
Complete the vaccination section, documenting the administration of Hepatitis B vaccine to the infant.
07
Fill out the laboratory testing results for both mother and infant regarding Hepatitis B.
08
Review all entries for accuracy, ensuring all sections are completed.
09
Sign and date the form to confirm the information is correct.
10
Submit the completed form to the Montana Department of Public Health and Human Services as instructed.
Who needs Montana Perinatal Hepatitis B Prevention Program Hospital/Birth Facility Report Form?
01
The Montana Perinatal Hepatitis B Prevention Program Hospital/Birth Facility Report Form is needed by healthcare providers, hospitals, and birth facilities that care for mothers and infants at risk of Hepatitis B infection.
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What is Montana Perinatal Hepatitis B Prevention Program Hospital/Birth Facility Report Form?
The Montana Perinatal Hepatitis B Prevention Program Hospital/Birth Facility Report Form is a document used to report cases of Hepatitis B in newborns to ensure proper monitoring and prevention of transmission from mother to child.
Who is required to file Montana Perinatal Hepatitis B Prevention Program Hospital/Birth Facility Report Form?
The hospitals and birth facilities that provide care for newborns whose mothers are positive for Hepatitis B are required to file the Montana Perinatal Hepatitis B Prevention Program Hospital/Birth Facility Report Form.
How to fill out Montana Perinatal Hepatitis B Prevention Program Hospital/Birth Facility Report Form?
To fill out the form, healthcare providers must enter specific information regarding the mother’s Hepatitis B status, the infant’s birth details, vaccination administered, and any follow-up testing conducted for the newborn.
What is the purpose of Montana Perinatal Hepatitis B Prevention Program Hospital/Birth Facility Report Form?
The purpose of the form is to facilitate the documentation and monitoring of Hepatitis B prevention efforts, ensuring that newborns at risk receive appropriate medical interventions and care.
What information must be reported on Montana Perinatal Hepatitis B Prevention Program Hospital/Birth Facility Report Form?
The report must include maternal Hepatitis B status, infant's date of birth, vaccination information, any follow-up tests for the infant, and details about the medical care provided.
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