Get the free CASE REPORT FORM Pertussis - Institute of Environmental - surv esr cri

Page 1 of 3 CASE REPORT FORM Pertussis Epicure No. Reporting Authority Name of Public Health Officer responsible for case Notifier Identification Reporting source* General Practitioner Hospital based

How to fill out case report form pertussis

How to fill out case report form pertussis:

1. Begin by gathering all the necessary information such as the patient's personal details, including their name, age, and contact information.
2. Document the onset of symptoms and the date of diagnosis for the pertussis infection.
3. Record any relevant medical history or pre-existing conditions that may have contributed to the development or severity of the pertussis infection.
4. Include details about the patient's symptoms and the progression of the illness. Document the duration and severity of coughing fits, presence of whooping sounds, and any associated complications.
5. Provide information about any medical interventions or treatments given to the patient, including medications, immunizations, or hospitalizations.
6. Include information about any laboratory tests or diagnostic procedures that were conducted, such as nasal swabs, blood tests, or x-rays, and their results.
7. Document any follow-up appointments or referrals made for the patient's ongoing care, including the names of healthcare providers or specialists involved.
8. Complete any additional sections or questions specific to the pertussis case report form as required by local or national health authorities.

Who needs case report form pertussis:

1. Medical professionals and healthcare providers who have diagnosed or treated a patient with pertussis.
2. Public health departments or agencies collecting data on pertussis cases for surveillance and monitoring purposes.
3. Researchers or organizations conducting studies or epidemiological investigations related to pertussis and its impact on public health.

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What is case report form pertussis?

Case report form pertussis is a document used by healthcare professionals to report cases of pertussis (whooping cough) to the appropriate authorities for tracking and monitoring purposes.

Who is required to file case report form pertussis?

Healthcare providers, laboratories, and other healthcare facilities are required to file case report form pertussis for any suspected or confirmed cases of pertussis.

How to fill out case report form pertussis?

Case report form pertussis can be filled out electronically or manually with information on the patient's demographics, symptoms, laboratory test results, and vaccination history.

What is the purpose of case report form pertussis?

The purpose of case report form pertussis is to track and monitor cases of pertussis in order to prevent outbreaks and implement appropriate public health interventions.

What information must be reported on case report form pertussis?

Information such as patient demographics, symptoms, laboratory test results, vaccination history, and healthcare provider contact information must be reported on case report form pertussis.