Get the free 2013 Novel Influenza A Case Screening Form - dhhr wv

This form may be used by local health departments for cases under investigation for possible human infection with novel influenza A viruses.

How to fill out 2013 novel influenza a

How to fill out 2013 Novel Influenza A Case Screening Form

1. Obtain the 2013 Novel Influenza A Case Screening Form from the appropriate health authority or website.
2. Fill in the patient's personal information at the top of the form, including name, date of birth, and contact details.
3. Provide details about the patient's symptoms, including the onset date and severity of symptoms.
4. Indicate any recent travel history and contact with confirmed cases of Novel Influenza A.
5. Document the patient's medical history, including any pre-existing conditions that may affect their health.
6. Ensure all sections of the form are completed accurately and legibly.
7. Review the filled form for any errors or missing information.
8. Submit the form to the designated health authority or facility as instructed.

Who needs 2013 Novel Influenza A Case Screening Form?

1. Public health authorities need the 2013 Novel Influenza A Case Screening Form to assess and monitor potential cases.
2. Healthcare providers require the form to document and report suspected cases of Novel Influenza A.
3. Researchers or epidemiologists may need the form for data collection and analysis.

For pdfFiller’s FAQs

What is 2013 Novel Influenza A Case Screening Form?

The 2013 Novel Influenza A Case Screening Form is a document used to assess individuals for potential infection with the H7N9 strain of influenza A that emerged in 2013.

Who is required to file 2013 Novel Influenza A Case Screening Form?

Healthcare providers who suspect a patient may have contracted the 2013 Novel Influenza A (H7N9) virus are required to file this form with health authorities.

How to fill out 2013 Novel Influenza A Case Screening Form?

To fill out the form, healthcare providers must provide patient identification details, travel history, symptoms, and any relevant exposure history to other confirmed cases.

What is the purpose of 2013 Novel Influenza A Case Screening Form?

The purpose of the form is to systematically collect information that helps in the early identification and containment of potential cases of H7N9 influenza.

What information must be reported on 2013 Novel Influenza A Case Screening Form?

The form must report patient demographics, clinical symptoms, travel history within the relevant timeframe, contact with infected individuals, and any history of exposure to poultry or wet markets.