Get the free kentucky reportable disease form

EPIC 394(Rev August 2014) Kentucky Reportable Disease Form Department for Public Health Division of Epidemiology and Health Planning 275 East Main St., Mail stop HS2EA Frankfort, KY 406210001 Hepatitis

How to fill out kentucky reportable disease form

How to fill out the Kentucky reportable disease form:

1. Start by obtaining a copy of the Kentucky reportable disease form. This can usually be found online on the official website of the Kentucky Department for Public Health.
2. Begin by providing your personal information in the designated fields. This may include your name, address, date of birth, contact number, and any other required details.
3. Next, enter the specific details of the disease or condition that needs to be reported. This includes the name of the disease, its classification, and any additional information requested by the form.
4. Provide information about the patient who has the disease. This includes their name, age, gender, and their contact information if different from yours.
5. Fill out the section that requires you to disclose any healthcare professional involved in the diagnosis, treatment, or referral of the patient.
6. Include the name and contact information of the facility or healthcare provider where the patient is receiving or received treatment.
7. If known, include the date of diagnosis or the onset of symptoms related to the disease.
8. Space will be provided to list any known risk factors, relevant travel history, or other relevant information that may assist in the reporting and investigation process.
9. If required, sign and date the form to certify the accuracy of the information provided.

Who needs the Kentucky reportable disease form?

1. Healthcare professionals: Any healthcare provider, such as physicians, nurses, and health clinic staff who diagnoses or suspects a reportable disease, is required to fill out and submit the Kentucky reportable disease form.
2. Laboratories: Any laboratory or testing facility that identifies a reportable disease is also required to complete the form and provide necessary information regarding the patient and the disease.
3. Epidemiologists and public health officials: These individuals are responsible for monitoring, tracking, and controlling the spread of diseases. They play a crucial role in analyzing the collected data from the reportable disease forms.

In summary, anyone involved in the diagnosis, treatment, or reporting of a reportable disease in Kentucky needs to fill out the Kentucky reportable disease form. This includes healthcare professionals, laboratories, and epidemiologists/public health officials.

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What is kentucky reportable disease form?

The Kentucky reportable disease form is a document used to report certain diseases to the health department in Kentucky.

Who is required to file kentucky reportable disease form?

Healthcare providers, laboratories, and other healthcare facilities are required to file the Kentucky reportable disease form.

How to fill out kentucky reportable disease form?

The Kentucky reportable disease form can be filled out online or submitted in person to the Kentucky health department.

What is the purpose of kentucky reportable disease form?

The purpose of the Kentucky reportable disease form is to track and monitor the occurrence of certain diseases in the state for public health purposes.

What information must be reported on kentucky reportable disease form?

The Kentucky reportable disease form typically requires information such as patient demographics, symptoms, and test results.