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Case number:Manitoba Health Airborne Disease Clinical Case Report Form (for use with Anaplasmosis, Babesiosis and Lyme disease infections) Patient Demographics Last name: First name: Middle name:
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To fill out the Manitoba Health Tick-Borne Disease form, follow these steps:
02
Start by providing your personal information, including your name, address, and contact details.
03
Fill in your date of birth and gender.
04
Specify the symptoms you are experiencing and any relevant medical history.
05
Indicate the date of the tick bite and the location where it occurred.
06
If you have any recent travel history, mention the countries or regions you have visited.
07
Provide the name and contact information of your healthcare provider.
08
Sign and date the form.
09
Submit the completed form to Manitoba Health for further processing.

Who needs manitoba health tick-borne disease?

01
Anyone who believes they may have contracted a tick-borne disease in Manitoba needs to fill out the Manitoba Health Tick-Borne Disease form. This includes residents of Manitoba as well as individuals who may have visited the province and suspect they have been exposed to ticks carrying diseases.
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Manitoba Health tick-borne disease refers to diseases transmitted by ticks in the Manitoba region.
Healthcare providers and laboratories are required to report cases of tick-borne diseases to Manitoba Health.
Healthcare providers and laboratories need to complete the reporting form provided by Manitoba Health with relevant information.
The purpose is to track and monitor cases of tick-borne diseases in Manitoba to aid in prevention and control efforts.
Information such as patient demographics, symptoms, tick exposure, and laboratory test results must be reported.
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