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Pertussis Surveillance Worksheet Appendix 11 NAME (Last, First) Hospital Record No. Address (Street and No.) City Reporting Physician/Nurse/Hospital/Clinic/Payphone County Address DEM161 Zip DEM165
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How to fill out pertussis surveillance worksheet
How to fill out pertussis surveillance worksheet
01
Step 1: Gather necessary information such as patient demographics (name, age, gender), date of symptom onset, and date of diagnosis.
02
Step 2: Fill out the patient's demographic information in the respective fields on the pertussis surveillance worksheet.
03
Step 3: Enter the date of symptom onset and date of diagnosis in the designated fields.
04
Step 4: Provide a detailed description of the patient's symptoms and any other relevant medical history.
05
Step 5: Include information about laboratory testing conducted, including the type of test performed and the results.
06
Step 6: Review the completed worksheet for accuracy and completeness.
07
Step 7: Submit or report the filled-out pertussis surveillance worksheet as per the designated guidelines.
Who needs pertussis surveillance worksheet?
01
Healthcare professionals involved in the diagnosis and management of pertussis cases.
02
Public health agencies responsible for monitoring and controlling the spread of pertussis.
03
Laboratories conducting pertussis testing and reporting.
04
Researchers studying pertussis and its epidemiology.
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What is pertussis surveillance worksheet?
The pertussis surveillance worksheet is a tool used to track and monitor cases of pertussis, also known as whooping cough.
Who is required to file pertussis surveillance worksheet?
Healthcare providers and facilities are required to file pertussis surveillance worksheets.
How to fill out pertussis surveillance worksheet?
Pertussis surveillance worksheets should be filled out with information on each case of pertussis, including symptoms, treatment, and outcome.
What is the purpose of pertussis surveillance worksheet?
The purpose of the pertussis surveillance worksheet is to help health authorities track and prevent outbreaks of pertussis.
What information must be reported on pertussis surveillance worksheet?
Information such as patient demographics, symptoms, vaccination history, and treatment received must be reported on the pertussis surveillance worksheet.
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