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B14.14 Attachment A (04/22/14) Varicella/Shingles Reporting Form Vaccines must be administered within 5 days of the rash ONSET. (Not the date of Provider diagnosis) Onset date: Source Name and TDC

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How to fill out b-1414- varicella and shingles

How to fill out b-1414- varicella and shingles:

01

Begin by obtaining the b-1414- varicella and shingles form from the appropriate healthcare provider or facility. This form is typically used for reporting cases of varicella (chickenpox) and shingles.

02

Start by filling out the top section of the form, which usually requires your personal information such as name, address, date of birth, and contact details. Ensure that all the information provided is accurate and up to date.

03

Move on to the next section, which typically asks for details regarding the disease. Fill in the necessary information about the patient's diagnosis, including the date of onset, location of lesions or rash, and any relevant medical history.

04

Provide additional information as required, such as the patient's vaccination history, history of exposure to others with varicella or shingles, and any complications or sequelae related to the disease.

05

If applicable, include details about any treatment the patient has received, such as antiviral medications or vaccinations.

06

Follow any additional instructions provided on the form, such as attaching supporting documents or signatures from healthcare professionals.

Who needs b-1414- varicella and shingles:

01

Healthcare providers: Doctors, nurses, and other healthcare professionals who diagnose or treat cases of varicella (chickenpox) and shingles may need to fill out the b-1414- form. This could be for the purpose of reporting the cases to relevant public health departments or for documentation purposes.

02

Public health officials: Government agencies or public health departments responsible for monitoring and tracking infectious diseases may require the b-1414- form to be filled out by healthcare providers. This helps in understanding the prevalence and spread of varicella and shingles in a specific region.

03

Research institutions: Researchers studying varicella and shingles may use the information collected on the b-1414- form for their studies and analysis. This can contribute to a better understanding of the diseases and may lead to advancements in prevention, treatment, and management of varicella and shingles.

In conclusion, the b-1414- varicella and shingles form should be filled out accurately and thoroughly by healthcare providers, public health officials, and researchers to report and track cases of varicella and shingles, as well as contribute to the overall understanding of these diseases.

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What is b-1414- varicella and shingles?

B-1414 is a form used to report cases of varicella (chickenpox) and shingles to health authorities.

Who is required to file b-1414- varicella and shingles?

Healthcare providers and facilities are required to file b-1414- varicella and shingles.

How to fill out b-1414- varicella and shingles?

The form should be completed with information about the patient, diagnosis, and treatment, then submitted to the appropriate health department.

What is the purpose of b-1414- varicella and shingles?

The purpose of the form is to track and monitor cases of varicella and shingles for public health purposes.

What information must be reported on b-1414- varicella and shingles?

Information such as patient demographics, date of diagnosis, type of varicella/shingles, and treatment administered must be reported on the form.

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