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LEPTOSPIROSIS Field version CASE INVESTIGATION FORM EPIC/DS/LENTO/FM/2008 EPIDEMIOLOGY UNIT, MINISTRY OF HEALTH The Public Health Inspector should investigate and complete this form. Medical Officer
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How to fill out leptospirosis special investigation form:

01
Obtain the leptospirosis special investigation form from the relevant authorities or healthcare provider.
02
Begin by providing your personal information, including your name, contact details, and any identifying numbers or codes required.
03
Fill in the date and time of onset of symptoms related to leptospirosis, if applicable.
04
Describe any recent exposure to potential sources of leptospirosis, such as contaminated water or animals.
05
Indicate any specific symptoms you're experiencing, such as fever, muscle pain, or jaundice.
06
Mention any relevant medical history or underlying conditions that may affect your susceptibility to leptospirosis.
07
Include details of any diagnostic tests or laboratory investigations conducted to confirm leptospirosis.
08
Provide information on any treatment you have received or are currently undergoing for leptospirosis.
09
If applicable, provide information on any hospitalization or need for further medical intervention.
10
Sign and date the form to indicate your consent and agreement with the information provided.

Who needs leptospirosis special investigation form:

01
Individuals who present with symptoms suggestive of leptospirosis should complete the special investigation form. This includes individuals who have been exposed to potential sources of leptospirosis, such as contaminated water, soil, or contact with animals.
02
Healthcare providers who suspect a case of leptospirosis and require comprehensive information for diagnosis, treatment, and surveillance purposes may also need the form. This allows them to collect standardized data and report cases to public health authorities for monitoring and control measures.
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Leptospirosis special investigation form is a document used to gather specific information about cases of leptospirosis for surveillance and control purposes.
Healthcare providers, hospitals, and laboratories are required to file leptospirosis special investigation form.
Leptospirosis special investigation form can be filled out by providing detailed information about the patient, symptoms, exposure history, and laboratory test results.
The purpose of leptospirosis special investigation form is to track and monitor cases of leptospirosis for public health reasons.
Information such as patient demographics, symptom onset dates, risk factors, exposure history, and laboratory test results must be reported on leptospirosis special investigation form.
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