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Page 1 of 1 March 2007 PERTUSSIS SUPPLEMENTARY CONTACT LIST Index Case Name: HCP#: Diagnosis: Community:

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What is pertussis supplementary contact list?

Pertussis supplementary contact list is a list of individuals who have been in close contact with someone diagnosed with pertussis.

Who is required to file pertussis supplementary contact list?

Healthcare providers or public health authorities are required to file pertussis supplementary contact list.

How to fill out pertussis supplementary contact list?

Pertussis supplementary contact list should be filled out with the names, contact information, and relationship to the diagnosed individual of all close contacts.

What is the purpose of pertussis supplementary contact list?

The purpose of pertussis supplementary contact list is to track and notify individuals who may have been exposed to pertussis in order to prevent further spread of the disease.

What information must be reported on pertussis supplementary contact list?

The pertussis supplementary contact list must include the names, contact information, and relationship to the diagnosed individual of all close contacts.

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