Get the free Zika Case Supplemental Form

Zika Case Supplemental Form Acute Communicable Disease Control 313 N. Figueroa St., Rm. 212 Los Angeles, CA 90012 2132407941 (phone), 2134824856 (facsimile) publichealth.lacounty.gov/acd/ To be filled

How to fill out zika case supplemental form

How to fill out zika case supplemental form

1. Step 1: Obtain a copy of the zika case supplemental form from the relevant local health authority or online.
2. Step 2: Carefully read the instructions provided with the form to understand all the necessary information and requirements.
3. Step 3: Begin filling out the form by providing the personal details of the individual affected by zika virus, such as their full name, date of birth, and contact information.
4. Step 4: Fill in the relevant medical information, including the date of diagnosis, symptoms experienced, and any complications or co-infections.
5. Step 5: Provide information about recent travel history, indicating whether the individual has traveled to areas with known zika transmission.
6. Step 6: Fill out any additional sections or questions as required by the form, such as information about pregnancy status or laboratory testing.
7. Step 7: Review the completed form to ensure all the necessary information is accurately provided.
8. Step 8: Sign and date the form, acknowledging that the information provided is true and accurate to the best of your knowledge.
9. Step 9: Submit the completed form to the designated local health authority or follow the specified instructions for submission.

Who needs zika case supplemental form?

1. Any individual who has been diagnosed with zika virus or suspects they may have contracted the virus needs to fill out the zika case supplemental form.
2. This form is required by the local health authorities to track and monitor zika virus cases for public health purposes.
3. Medical professionals, healthcare facilities, and laboratories may also be required to complete this form when reporting zika virus cases.

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What is zika case supplemental form?

The zika case supplemental form is a form used to provide additional information and details about confirmed cases of Zika virus.

Who is required to file zika case supplemental form?

Healthcare providers and laboratories are required to file the zika case supplemental form.

How to fill out zika case supplemental form?

The zika case supplemental form can be filled out online or by submitting a paper form with necessary information about the confirmed Zika virus case.

What is the purpose of zika case supplemental form?

The purpose of zika case supplemental form is to gather detailed information about Zika virus cases for monitoring, prevention, and control measures.

What information must be reported on zika case supplemental form?

Information such as patient demographics, symptoms, date of diagnosis, travel history, pregnancy status, and laboratory test results must be reported on zika case supplemental form.