Get the free Shigellosis Case Report Form - Florida Department of Health

Version 1.2, March 2012 Shigellosis Case Report Form This form is designed to aid in completing the Extended Data screen in Merlin for shigellosis cases. *Blue fields are REQUIRED Merlin case #: Date

How to fill out shigellosis case report form

How to fill out a shigellosis case report form:

1. Start by gathering the necessary information: Collect all relevant details about the affected individual, including their name, age, contact information, and demographic information (such as gender and race). Additionally, obtain their medical history, symptoms experienced, and any known exposures to the Shigella bacteria.
2. Document the date of symptom onset: Record the date when the affected individual first experienced symptoms related to shigellosis. This information is crucial for tracking the progression of the disease and identifying potential outbreaks.
3. Include details about laboratory testing: If the affected individual has undergone laboratory testing to confirm the presence of Shigella bacteria, provide the date of testing, the type of laboratory test performed (such as stool culture or polymerase chain reaction), and the name of the laboratory conducting the analysis.
4. Describe the treatment administered: Note any medical interventions given to the affected individual, such as antibiotics or supportive care. Include the name of the medication, dosage, duration of treatment, and prescribing healthcare professional.
5. Provide information about the case outcome: Indicate whether the affected individual recovered from shigellosis, required hospitalization, or experienced any complications. If the individual passed away due to the infection, specify the date and cause of death.
6. Add contact tracing details: If applicable, include information about any close contacts of the affected individual who may have been exposed to Shigella bacteria. Provide their names, contact information, and any relevant details about their health status or symptoms.

Who needs a shigellosis case report form?

Healthcare professionals, including physicians, nurses, and epidemiologists, typically require shigellosis case report forms. These forms serve as a standardized means of documenting and reporting cases of shigellosis to public health authorities. By collecting and analyzing data from reported cases, health officials can monitor the incidence and prevalence of shigellosis, identify potential outbreaks, and develop effective prevention and control strategies. Additionally, the information gathered through these forms aids in conducting epidemiological research and advancing our understanding of shigellosis.

For pdfFiller’s FAQs

What is shigellosis case report form?

Shigellosis case report form is a document used to report cases of shigellosis to the appropriate health authorities.

Who is required to file shigellosis case report form?

Healthcare providers, hospitals, laboratories, and other healthcare facilities are required to file shigellosis case report form.

How to fill out shigellosis case report form?

To fill out shigellosis case report form, include information such as patient demographics, symptoms, laboratory results, and possible sources of infection.

What is the purpose of shigellosis case report form?

The purpose of shigellosis case report form is to track and monitor cases of shigellosis, identify outbreaks, and implement control measures to prevent further spread.

What information must be reported on shigellosis case report form?

Information that must be reported on shigellosis case report form include patient demographics, symptoms, laboratory results, possible sources of infection, and any relevant travel history.

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