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PERTUSSIS CONTACT WORKSHEET First: Last: No. Name of contact (phone) Type Age Sex Relationship.
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The pertussis contact worksheet is a form used to gather information about individuals who have been in contact with someone diagnosed with pertussis.
Healthcare providers and public health agencies are required to file pertussis contact worksheets.
To fill out a pertussis contact worksheet, healthcare providers must gather information about the individuals who have been in contact with the pertussis patient and report it on the form.
The purpose of the pertussis contact worksheet is to track and monitor individuals who may have been exposed to pertussis in order to prevent further spread of the disease.
Information such as the names of the contacts, their contact information, dates of exposure, and any symptoms they may be experiencing must be reported on the pertussis contact worksheet.
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