Get the free 14-204 Varicella Reporting Form - Brownsville Independent School ... - bisd

Brownsville Independent School District Health Services 708 Palm Blvd. Ste. 111, Brownsville, Texas 78520 VARICELLA (chickenpox) Please use this form to report cases of varicella to Central Health

How to fill out 14-204 varicella reporting form

How to fill out 14-204 varicella reporting form:

1. Obtain the 14-204 varicella reporting form from the appropriate authority or organization.
2. Fill out the top section of the form with your personal information, including your name, contact information, and any relevant identification number.
3. Provide the necessary details about the patient, such as their name, date of birth, and contact information.
4. Indicate the date of diagnosis for the varicella (chickenpox) infection.
5. Specify the facility or provider who made the diagnosis and provide their contact information.
6. Include information about the varicella vaccine, if applicable, such as the date it was administered and any relevant documentation.
7. If the patient received treatment for varicella, indicate the type of treatment, medications used, and duration.
8. Document any complications or additional relevant information regarding the varicella infection.
9. Sign and date the form to certify the accuracy of the information provided.
10. Submit the completed 14-204 varicella reporting form to the designated authority or organization.

Who needs 14-204 varicella reporting form:

1. Healthcare Professionals: Medical practitioners, doctors, nurses, or any other healthcare professionals who have diagnosed or treated a patient with varicella (chickenpox) may need to fill out the 14-204 varicella reporting form.
2. Public Health Authorities: Government health agencies, state or local public health departments, or any other relevant health authorities may require the 14-204 varicella reporting form for surveillance and tracking of varicella cases.
3. Educational Institutions: Schools, childcare centers, or other educational institutions might request the 14-204 varicella reporting form to maintain a record of varicella cases among students and staff, in line with their health and safety protocols.
4. Research Organizations: Researchers or research institutions studying varicella or conducting epidemiological studies may use the 14-204 varicella reporting form to collect data for their research purposes.

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What is 14-204 varicella reporting form?

The 14-204 varicella reporting form is a document used to report cases of varicella (chickenpox) to health authorities.

Who is required to file 14-204 varicella reporting form?

Healthcare providers, such as doctors and hospitals, are required to file the 14-204 varicella reporting form.

How to fill out 14-204 varicella reporting form?

The 14-204 varicella reporting form can be filled out online or submitted in paper form with all the required information about the varicella cases.

What is the purpose of 14-204 varicella reporting form?

The purpose of the 14-204 varicella reporting form is to track and monitor varicella cases for public health purposes.

What information must be reported on 14-204 varicella reporting form?

Information such as patient demographics, symptoms, date of diagnosis, and treatment provided must be reported on the 14-204 varicella reporting form.