KS KDHE Reportable Disease Form 2014 free printable template

KANSAS REPORTABLE DISEASE FORMTodays Date: / / Patients Name: LastFirstMiddleHome/Cell Phone:Work Phone:Residential Address: City:Zip:Ethnicity: Race:County:Hispanic or Latino Hispanic or LatinoUnknown(Check

How to fill out KS KDHE Reportable Disease Form

How to fill out KS KDHE Reportable Disease Form

1. Obtain the KS KDHE Reportable Disease Form from the Kansas Department of Health and Environment website or your local health department.
2. Fill in the patient's personal information, including full name, date of birth, gender, and contact details.
3. Provide the date of the report and the name of the reporting facility or provider.
4. Indicate the specific disease or condition being reported from the list of reportable diseases.
5. Add the date of diagnosis and any relevant clinical or laboratory information.
6. Include details about the patient's address and possible exposure history.
7. Sign and date the form to validate the report.
8. Submit the form according to the instructions provided (usually via fax, mail, or online submission).

Who needs KS KDHE Reportable Disease Form?

1. Healthcare providers who diagnose or suspect reportable diseases.
2. Laboratories that perform tests for reportable diseases.
3. Public health officials who need to monitor and control disease outbreaks.

People Also Ask about

What diseases are reportable to the CDC?

Nationally Notifiable Diseases Cholera. Cryptosporidiosis. Cyclosporiasis. Giardiasis. Hepatitis A. Legionellosis. Malaria* Salmonellosis.

What does it mean if a disease is reportable?

Notifiable disease. A disease that, when diagnosed, requires health providers (usually by law) to report to state or local public health officials. Notifiable diseases are of public interest by reason of their contagiousness, severity, or frequency.

What is the difference between reportable and notifiable diseases?

Reportable diseases are diseases that must be brought to the attention of ISDA immediately, as soon as identified. Notifiable diseases are diseases that must be brought to the attention of ISDA within 48 hours of discovery.

What makes a disease reportable?

A disease that, when diagnosed, requires health providers (usually by law) to report to state or local public health officials. Notifiable diseases are of public interest by reason of their contagiousness, severity, or frequency.

What are the reportable diseases in Kansas?

Suspected Act of Terrorism Anthrax. Botulism. Brucellosis. Plague. Tularemia. Q fever. Smallpox. Viral hemorrhagic fever.

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What is KS KDHE Reportable Disease Form?

The KS KDHE Reportable Disease Form is a document used to report cases of specific diseases that are mandated to be reported to the Kansas Department of Health and Environment (KDHE) to monitor public health and prevent outbreaks.

Who is required to file KS KDHE Reportable Disease Form?

Healthcare providers, laboratories, and other entities that diagnose or treat reportable diseases are required to file the KS KDHE Reportable Disease Form, as part of their public health obligations.

How to fill out KS KDHE Reportable Disease Form?

To fill out the KS KDHE Reportable Disease Form, include complete patient information, details of the disease diagnosis, date of onset, and any relevant laboratory results, ensuring that all required sections are completed accurately.

What is the purpose of KS KDHE Reportable Disease Form?

The purpose of the KS KDHE Reportable Disease Form is to facilitate the monitoring, control, and prevention of communicable diseases within Kansas by ensuring prompt reporting of cases to public health authorities.

What information must be reported on KS KDHE Reportable Disease Form?

The information that must be reported includes the patient's name, contact information, date of birth, the disease being reported, date of diagnosis, reporting source, and any pertinent clinical and laboratory findings.