Get the free Varicella Reporting Form for Schools & Childcare Facilities - azdhs

Please submit this form to your local county health department Varicella (Chickenpox) Reporting Form School based Varicella Sentinel Surveillance System For schools and child care facilities for reporting

How to fill out varicella reporting form for

How to fill out varicella reporting form for

1. Start by downloading the varicella reporting form from the official website or obtain a hard copy from the local health department.
2. Fill out the patient's information section, including their full name, date of birth, gender, and contact information.
3. Provide details about the date of onset of the varicella infection and the date of diagnosis.
4. Indicate the severity of the illness by selecting the appropriate option from the provided choices.
5. Specify if the patient has received any varicella vaccination and provide the date(s) of vaccination, if applicable.
6. Include additional information about any complications, hospitalizations, or other relevant medical history related to varicella.
7. Complete the healthcare provider's information section, including name, contact details, and signature.
8. Review the form for accuracy and completeness before submitting it to the appropriate health authorities.
9. Keep a copy of the filled-out varicella reporting form for your records.
10. Follow any additional instructions provided by the local health department or relevant authorities.
11. Submit the completed varicella reporting form as per the guidelines provided by the health department.

Who needs varicella reporting form for?

1. Healthcare providers: Varicella reporting forms are typically required to be completed by healthcare providers who diagnose and treat patients with varicella.
2. Laboratories: Testing laboratories performing varicella diagnostic tests may also need to complete varicella reporting forms to report positive cases.
3. Schools and childcare facilities: These institutions may require varicella reporting forms from parents or guardians to track and monitor cases of varicella among students and staff.
4. Public health authorities: Varicella reporting forms are essential for public health authorities to gather data and monitor the spread of varicella in the community.
5. Researchers and epidemiologists: Individuals conducting research or studying varicella may utilize varicella reporting forms to collect data for analysis and evaluation.

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What is varicella reporting form for?

Varicella reporting form is used to report cases of chickenpox (varicella) to the appropriate health authorities for tracking and monitoring purposes.

Who is required to file varicella reporting form for?

Healthcare providers, hospitals, and other medical facilities are required to file varicella reporting forms for any confirmed cases of chickenpox.

How to fill out varicella reporting form for?

Varicella reporting forms can typically be filled out online or submitted via fax or mail. The form usually requires basic information about the patient, such as name, age, date of diagnosis, and contact information.

What is the purpose of varicella reporting form for?

The purpose of varicella reporting form is to track and monitor cases of chickenpox in order to prevent outbreaks, protect public health, and implement appropriate control measures.

What information must be reported on varicella reporting form for?

Information that must be reported on varicella reporting form typically includes patient demographics, date of diagnosis, clinical symptoms, and laboratory confirmation of varicella.