Get the free WISCONSIN LYME DISEASE CASE REPORT FORM

This document is used for reporting Lyme disease cases in Wisconsin, including patient and physician information, demographics, laboratory findings, clinical signs and symptoms, exposure information,

How to fill out wisconsin lyme disease case

How to fill out WISCONSIN LYME DISEASE CASE REPORT FORM

1. Start by downloading the Wisconsin Lyme Disease Case Report Form from the official health department website.
2. Fill in the patient's personal information, including name, date of birth, address, and contact information.
3. Provide the date of symptom onset and the date of diagnosis.
4. Indicate whether the patient has had a history of tick bites or potential exposure to tick habitats.
5. Document the specific symptoms the patient is experiencing, such as fever, chills, headache, or rash.
6. Include any laboratory test results relevant to the diagnosis of Lyme disease.
7. Specify the treatment administered to the patient and the response to treatment.
8. Sign and date the form to confirm the information is accurate.
9. Submit the completed form to the appropriate public health authority as indicated on the form.

Who needs WISCONSIN LYME DISEASE CASE REPORT FORM?

1. Health care providers who diagnose Lyme disease in patients.
2. Laboratories that confirm Lyme disease cases through testing.
3. Public health officials who track and monitor the incidence of Lyme disease in Wisconsin.

People Also Ask about

Does Justin Bieber have Lyme disease?

Lyme disease. In the years I've been writing about health, celebrities including Avril Lavigne, her fellow Canadian superstars Shania Twain and Justin Bieber, plus model Bella Hadid and actress Riley Keough have all shared that they have the condition, which is caught via tick bites.

Does Lyme disease have to be reported?

Lyme disease has been a nationally notifiable condition in the United States since 1991. Reports of Lyme disease are routinely collected and verified by state and local health departments in accordance with their legal mandate and surveillance practices.

Did Justin Bieber get Lyme disease?

In January 2020, Justin Bieber revealed on Instagram that he was diagnosed with Lyme disease along with "a serious case of chronic mono."

What is the sample for Lyme disease?

A blood sample is needed. A laboratory specialist looks for Lyme disease antibodies in the blood sample using the ELISA test. If the ELISA test is positive, it must be confirmed with another test called the Western blot test.

Does Lyme disease need to be reported?

Lyme disease has been a nationally notifiable condition in the United States since 1991. Reports of Lyme disease are routinely collected and verified by state and local health departments in accordance with their legal mandate and surveillance practices.

How many cases of Lyme disease are there in Wisconsin?

Wisconsin had 6,469 cases of Lyme disease in 2024, the highest on record. On average, about 4,600 cases were reported each year during 2019-2023. The incidence of reported Lyme disease cases has quadrupled over the past 20 years.

What happens if Lyme disease goes untreated?

Untreated Lyme disease can produce a wide range of symptoms, depending on the stage of infection. These include fever, rash, facial paralysis, an irregular heartbeat, and arthritis.

How common is Lyme after a tick bite?

Not all ticks carry the Lyme disease bacteria. Depending on the location, anywhere from less than 1 in 100 to more than half of the ticks are infected with it. While most tick bites are harmless, several species can cause life-threatening diseases.

For pdfFiller’s FAQs

What is WISCONSIN LYME DISEASE CASE REPORT FORM?

The Wisconsin Lyme Disease Case Report Form is a standardized document used to report cases of Lyme disease to public health authorities in Wisconsin. It is designed to collect essential information about the patient's clinical presentation, exposure history, and diagnostic results.

Who is required to file WISCONSIN LYME DISEASE CASE REPORT FORM?

Healthcare providers, including doctors and clinics, are required to file the Wisconsin Lyme Disease Case Report Form when they diagnose a patient with Lyme disease or suspect a case based on clinical symptoms.

How to fill out WISCONSIN LYME DISEASE CASE REPORT FORM?

To fill out the Wisconsin Lyme Disease Case Report Form, complete all required sections, including patient demographics, clinical information, laboratory test results, and exposure history. Ensure that all information is accurate and legible before submitting the form to the appropriate health department.

What is the purpose of WISCONSIN LYME DISEASE CASE REPORT FORM?

The purpose of the Wisconsin Lyme Disease Case Report Form is to facilitate the monitoring and surveillance of Lyme disease cases, inform public health responses, and contribute to research aimed at understanding the epidemiology of the disease in Wisconsin.

What information must be reported on WISCONSIN LYME DISEASE CASE REPORT FORM?

The information that must be reported includes the patient's name, date of birth, address, clinical symptoms, date of diagnosis, laboratory test results, exposure history (such as tick bites), and any relevant medical history related to Lyme disease.