Get the free Arbovirus Case Report Form - nmhealthorg

NM DOH Arbovirus Case Report Form, June 2015 Arbovirus Case Report Form When completed, fax or mail this form to: Epidemiology and Response Division, NM DOH

How to fill out arbovirus case report form

How to fill out arbovirus case report form:

1. Start by carefully reviewing the instructions provided with the form. This will give you a clear understanding of what information needs to be included and how it should be formatted.
2. Begin by filling out the basic contact information section, including your name, contact details, and the date of the report. Make sure all the information is accurate and up-to-date.
3. Provide the necessary demographic details of the affected individual(s), including their age, gender, and any relevant medical history. This will help health officials analyze the data effectively.
4. Specify the arbovirus being reported, such as dengue fever, Zika virus, or West Nile virus. Include any available laboratory test results or evidence that confirms the diagnosis.
5. Detail the onset and duration of symptoms experienced by the affected individual(s). Include dates, specific symptoms observed, and any complications or severe outcomes.
6. Provide information about the location and potential source of exposure. This could include the affected individual(s)' travel history, residence, or any known mosquito breeding sites in the vicinity.
7. Explain the treatment provided, if any, and any preventive measures taken to control the spread of the arbovirus.
8. Finally, sign and date the form to certify its accuracy and completeness.

Who needs arbovirus case report form:

1. Healthcare professionals: Doctors, nurses, and medical staff who encounter patients with suspected arbovirus infections need to fill out the arbovirus case report form. This allows for accurate documentation and reporting of cases, aiding in the surveillance and control of arboviral diseases.
2. Public health agencies: Local health departments and government agencies require the arbovirus case report form to track and monitor the occurrence and spread of arboviral diseases within their jurisdiction. This information is crucial for implementing appropriate preventive measures and providing timely public health interventions.
3. Epidemiologists and researchers: Arbovirus case report forms provide valuable data for epidemiological studies and research on arboviral diseases. Researchers can analyze the collected information to better understand risk factors, disease patterns, and guide public health strategies.

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