Get the free Pertussis Case Report Form - health qld gov
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This document is a case report form used for notifying and gathering information about cases of pertussis (whooping cough) as part of public health surveillance.
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How to fill out pertussis case report form
How to fill out Pertussis Case Report Form
01
Start by obtaining the Pertussis Case Report Form from your local health department or healthcare provider.
02
Fill in the patient's personal information, including full name, date of birth, sex, and contact information.
03
Provide details about the patient's symptoms, including the onset date and duration of cough, as well as any other relevant symptoms.
04
Identify the patient's vaccination history, including dates and types of pertussis vaccinations received.
05
Document any known exposures to pertussis, such as contact with infected individuals.
06
Include relevant laboratory test results, if available, indicating the presence of pertussis bacteria (e.g., PCR or culture results).
07
Complete sections regarding the patient's clinical history and any other pertinent medical background.
08
Sign and date the form, then submit it to the appropriate health authority as instructed.
Who needs Pertussis Case Report Form?
01
Any healthcare provider or public health official who suspects a case of pertussis in a patient.
02
Clinicians responsible for managing reported outbreaks of pertussis.
03
Schools or childcare facilities notifying health departments of suspected cases.
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What is Pertussis Case Report Form?
The Pertussis Case Report Form is a standardized document used for reporting cases of whooping cough, a highly contagious respiratory disease caused by the bacterium Bordetella pertussis.
Who is required to file Pertussis Case Report Form?
Health care providers and laboratories are typically required to file the Pertussis Case Report Form for confirmed or suspected cases of pertussis to public health authorities.
How to fill out Pertussis Case Report Form?
To fill out the Pertussis Case Report Form, health care providers should provide detailed patient information, including demographics, clinical symptoms, laboratory test results, vaccination history, and any relevant epidemiological data.
What is the purpose of Pertussis Case Report Form?
The purpose of the Pertussis Case Report Form is to facilitate the monitoring and control of pertussis outbreaks, improve disease surveillance, and inform public health response efforts.
What information must be reported on Pertussis Case Report Form?
The information required on the Pertussis Case Report Form typically includes patient demographics, clinical signs and symptoms, vaccination status, laboratory test results, and contact history with known cases of pertussis.
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