Get the free Severe Influenza Case History Form ICU and Fatal Cases - rivco-diseasecontrol

Appendix A Severe Influenza Case History Form (ICU and Fatal Cases Age 064 Years) Case definition: 1) lab confirmed flu of any type; and 2) hospitalized in an ICU OR expired at any location (e.g.

How to fill out severe influenza case history

1. Start by gathering the necessary information. The severe influenza case history form usually requires details such as personal information (name, age, gender), contact information, and medical history. Make sure to have these details ready before filling out the form.
2. Begin with the patient's personal information. Fill in their full name, date of birth, gender, and any other relevant information requested in this section.
3. Provide the patient's contact information. Include their address, phone number, and email address if required. This will ensure effective communication between healthcare professionals if needed.
4. Move on to the medical history section. Here, you will provide information about any pre-existing medical conditions the patient may have, such as asthma, diabetes, heart disease, or any other relevant conditions. Include details about any ongoing medications, allergies, or previous surgeries.
5. Describe the influenza symptoms. Note down the onset date of symptoms, such as fever, cough, sore throat, body aches, and fatigue. Specify any complications experienced, such as difficulty breathing or chest pain.
6. Mention any known exposure to the influenza virus. If the patient has been in contact with someone diagnosed with influenza, traveled to a high-risk area, or had any other potential exposure, provide these details in this section.
7. Record the patient's vaccination history. Indicate whether the patient has received the influenza vaccine and note the dates of immunization if applicable. If the patient has not received the vaccine, provide their reasons for not doing so.
8. Include any relevant laboratory test results. If the patient has undergone any tests related to influenza, such as a nasal swab or blood tests, include the results if available.
9. Finalize the form by signing and dating it. Ensure that all information provided is accurate and complete before signing the form.
10. Regarding who needs the severe influenza case history, it is typically required by healthcare professionals, including doctors, nurses, or public health officials. These records help in accurately diagnosing and managing severe influenza cases, monitoring outbreaks, and tracking the effectiveness of vaccination programs.

For pdfFiller’s FAQs

What is severe influenza case history?

Severe influenza case history is a record of an individual's experience with a severe case of the influenza virus.

Who is required to file severe influenza case history?

Healthcare providers and medical facilities are required to file severe influenza case history for patients who have been diagnosed with severe cases of influenza.

How to fill out severe influenza case history?

Severe influenza case history can be filled out by providing detailed information about the patient's symptoms, treatment, and outcomes related to the severe case of influenza.

What is the purpose of severe influenza case history?

The purpose of severe influenza case history is to track and monitor severe cases of influenza in order to better understand the virus and improve treatment strategies.

What information must be reported on severe influenza case history?

Information such as patient demographics, symptoms, treatment received, laboratory test results, and outcomes must be reported on severe influenza case history.

When is the deadline to file severe influenza case history in 2024?

The deadline to file severe influenza case history in 2024 is December 31st.

What is the penalty for the late filing of severe influenza case history?

The penalty for the late filing of severe influenza case history may vary depending on the regulations in place, but can include fines or disciplinary action.

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