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This document provides an overview of the revised Congenital Syphilis (CS) report form, including updates to data collection and algorithms for case classification. It highlights changes that aim

How to fill out revised congenital syphilis report

How to fill out Revised Congenital Syphilis Report Form

1. Obtain the Revised Congenital Syphilis Report Form from the appropriate health authority.
2. Fill out the patient's demographic information, including name, date of birth, and contact details.
3. Indicate the mother's information, including her name, date of birth, and syphilis treatment history.
4. Document the infant's clinical information, including birth weight, gestational age, and any symptoms of syphilis.
5. Report the laboratory results, including any serological tests conducted for syphilis.
6. Provide the details of the healthcare provider filling out the form, including name and contact information.
7. Review the completed form for accuracy before submission.
8. Submit the form to the appropriate health department as per local guidelines.

Who needs Revised Congenital Syphilis Report Form?

1. Healthcare professionals who have delivered a child diagnosed with congenital syphilis.
2. Medical staff involved in the treatment and follow-up of affected infants.
3. Public health officials requiring data for epidemiological tracking and prevention efforts.
4. Parents or guardians of infants diagnosed with congenital syphilis for medical records.

For pdfFiller’s FAQs

What is Revised Congenital Syphilis Report Form?

The Revised Congenital Syphilis Report Form is a standardized document used by healthcare providers to report cases of congenital syphilis, an infection in infants that can occur if the mother has syphilis during pregnancy.

Who is required to file Revised Congenital Syphilis Report Form?

Healthcare providers, including physicians and hospitals, are required to file the Revised Congenital Syphilis Report Form when a case of congenital syphilis is diagnosed.

How to fill out Revised Congenital Syphilis Report Form?

The Revised Congenital Syphilis Report Form should be filled out by providing accurate demographic information, clinical details about the infant and mother, and any relevant laboratory test results, along with the signature of the reporting healthcare provider.

What is the purpose of Revised Congenital Syphilis Report Form?

The purpose of the Revised Congenital Syphilis Report Form is to monitor and control the incidence of congenital syphilis, facilitate public health responses, and ensure proper treatment and follow-up for affected infants.

What information must be reported on Revised Congenital Syphilis Report Form?

Information that must be reported includes the infant's demographics, maternal syphilis history, test results, clinical findings, treatment provided, and follow-up plans.