Get the free INFLUENZA SURVEILLANCE SUBMISSION FORM

Specimens testing negative for influenza will typically be cultured for Parainfluenza 1 2 3 Adenovirus RSV. SPECIMEN TYPE Swab specimens must be submitted in Viral Transport Media VTM. Upper Respiratory Specimen type Nasopharyngeal Swab VTM Nasal Swab VTM Dual Nasopharyngeal / Throat Swabs VTM Nasal Aspirate or Wash Lower Respiratory Specimen type Bronchoalveolar Lavage Bronchial Wash Tracheal Aspirate Sputum Lung Tissue Surveillance Data Yes No Unk Was patient vaccinated against influenza...

How to fill out influenza surveillance submission form

How to fill out influenza surveillance submission form

1. Step 1: Obtain the influenza surveillance submission form from the designated authority.
2. Step 2: Fill in the personal information section of the form, including your name, contact details, and any relevant identification numbers.
3. Step 3: Provide details about the patient, such as their name, age, gender, and address.
4. Step 4: Specify the healthcare facility or organization where the patient is being monitored or treated for influenza.
5. Step 5: Describe the symptoms exhibited by the patient and any relevant medical history.
6. Step 6: Include information about the influenza test performed, including the date, type of test, and results.
7. Step 7: Provide additional information, if any, such as complications or co-existing medical conditions.
8. Step 8: Review the completed form for accuracy and completeness before submitting it.

Who needs influenza surveillance submission form?

1. Healthcare professionals responsible for monitoring and reporting influenza cases.
2. Medical facilities and laboratories involved in diagnosing and treating influenza.
3. Public health agencies and organizations collecting data for influenza surveillance.
4. Researchers and scientists studying influenza and its spread.
5. Government agencies and departments responsible for public health monitoring and response.

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What is influenza surveillance submission form?

The influenza surveillance submission form is a document used to report data and information related to influenza cases and outbreaks to health authorities.

Who is required to file influenza surveillance submission form?

Healthcare facilities, medical professionals, and public health agencies are required to file the influenza surveillance submission form.

How to fill out influenza surveillance submission form?

The form typically requires information such as patient demographics, symptoms, lab tests results, and treatment provided. It should be filled out accurately and submitted to the relevant health authorities.

What is the purpose of influenza surveillance submission form?

The purpose of the form is to track and monitor influenza cases, identify trends, and implement appropriate public health interventions to prevent the spread of the virus.

What information must be reported on influenza surveillance submission form?

Information such as patient demographics, symptoms, lab tests results, treatment provided, and outbreak details must be reported on the influenza surveillance submission form.