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L ME D DISEASE I INVESTIGATION F ORM BASIC DEMOGRAPHIC DATA Last Name: First Name: Middle Name: DOB: / / Age: years months Current Sex: Female Male Unknown Is the patient deceased? No Unknown Yes
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What is lyme disease investigation form?
The lyme disease investigation form is a document used for reporting and collecting information regarding cases of lyme disease.
Who is required to file lyme disease investigation form?
Healthcare providers, such as doctors and clinics, are required to file the lyme disease investigation form for each confirmed or suspected case of lyme disease.
How to fill out lyme disease investigation form?
The lyme disease investigation form typically requires the healthcare provider to provide information about the patient, including their demographics, medical history, symptoms, and laboratory test results. The form may also include sections for capturing information about potential exposure to ticks and other relevant details.
What is the purpose of lyme disease investigation form?
The purpose of the lyme disease investigation form is to gather data on lyme disease cases to monitor the spread of the disease, investigate potential outbreaks, and inform public health interventions and prevention strategies.
What information must be reported on lyme disease investigation form?
The lyme disease investigation form generally requires the healthcare provider to report information such as patient demographics, medical history, symptoms, laboratory test results, potential tick exposure, and any related treatments or interventions.
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