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OMB No. 09200666 Exp. Date: 12312015 www.cdc.gov/nhsn Facility Contact Information Page 1 of 3 Tracking #: *required for saving *Facility Name: *Main Telephone Number: *Mailing Address: *City: *County:
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How to Fill Out CDC:

01
Gather the necessary information: Before filling out the CDC (Centers for Disease Control and Prevention) form, make sure you have all the required information handy. This may include personal details such as name, address, contact information, and medical history.
02
Follow the instructions: Review the instructions provided with the CDC form carefully. These instructions will guide you on how to properly complete each section of the form. Pay close attention to any specific requirements or additional documentation that may be needed.
03
Provide accurate information: It is crucial to provide accurate and up-to-date information when filling out the CDC form. Double-check the spelling of your name, ensure correct contact details are given, and provide any necessary medical or travel history accurately. This ensures that the form is effectively processed and any necessary precautions or recommendations can be made.
04
Complete all required sections: The CDC form usually consists of various sections that need to be completed. Make sure to fill out each section thoroughly and accurately. This may include sections on personal information, medical history, recent travel details, and any specific symptoms or health concerns.
05
Seek assistance if needed: If you are uncertain about how to fill out certain sections or have any questions regarding the CDC form, it is advisable to seek assistance. This can be obtained from healthcare professionals, travel agencies, or by contacting the CDC directly. It is important to have a thorough understanding of the form and provide the necessary information appropriately.

Who Needs CDC:

01
Travelers: The CDC form is often required for individuals traveling internationally. Many countries require travelers to complete and submit the CDC form to monitor and track potential health risks, especially during times of epidemics or pandemics. This helps in identifying any potential health concerns and taking appropriate measures to prevent the spread of diseases.
02
Healthcare Professionals: CDC forms may also be required by healthcare professionals who are dealing with patients or cases that involve communicable diseases. Completing the form helps in monitoring and tracking the spread of diseases, ensuring appropriate precautions are taken, and providing necessary healthcare services to affected individuals.
03
Individuals with specific health concerns: People with specific health concerns or conditions may also be required to fill out the CDC form. This is done to assess any potential risks or implications, provide appropriate recommendations or precautions, and ensure proper healthcare management in such cases.
Note: The specific requirements for who needs to fill out a CDC form may vary depending on the situation, location, and purpose. It is important to follow the guidelines provided by relevant authorities and stay updated with any changes or updates regarding the necessity of filling out the CDC form.
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CDC stands for Centers for Disease Control and Prevention, a national public health institute in the United States.
Certain healthcare providers and laboratories are required to file CDC reports.
CDC reports can be filled out online through the CDC's reporting system.
The purpose of CDC reports is to track and analyze the spread of diseases and monitor public health trends.
Information such as patient demographics, symptoms, and test results must be reported on CDC forms.
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