Get the free varicella reporting form colorado

Nat. Asian Black Other Pacif./Hawaiian Hispanic Ethnicity check appropriate box County White Unknown Non-Hispanic City Zip code Report date Name and title of person filling out form Phone number for site or person completing form Report Site Name of clinic/school/childcare center Site is Employer Health Department Laboratory Preschool / Childcare Physician School specify the grade level of the person with chickenpox Other specify Rash Onset date // mm dd OR yyyy 1st date child absent // due...

How to fill out varicella reporting form colorado

How to fill out varicella reporting form Colorado:

1. Obtain the form: The varicella reporting form can be obtained from the Colorado Department of Public Health and Environment's website or by contacting their office directly.
2. Fill out personal information: Start by providing your personal information, including your name, contact information, and any relevant identification numbers.
3. Provide patient details: Enter the details of the patient who has been diagnosed with varicella. This includes their name, date of birth, address, and contact information.
4. Specify healthcare provider information: Indicate the name and contact information of the healthcare provider who made the diagnosis of varicella for the patient. This can include their name, address, phone number, and any relevant medical license or identification number.
5. Record vaccination history: If the patient has received any varicella vaccinations, record the dates and types of vaccines administered. Include any additional information regarding the vaccines if requested on the form.
6. Describe symptoms and complications: Provide a detailed description of the patient's symptoms and any complications or hospitalization related to varicella. Include dates, duration, and any relevant medical treatment received.
7. Answer additional questions: The varicella reporting form may include additional questions regarding the patient's demographic information, exposure history, and any other relevant details. Answer these questions as accurately as possible.
8. Attach supporting documents: If there are any laboratory test results or medical records related to the varicella diagnosis, attach copies of them to the form. Ensure that all attachments are labeled and organized appropriately.
9. Review and submit: Before submitting the form, carefully review all the information provided to ensure its accuracy. Make any necessary corrections or additions before signing and dating the form. Follow the specified submission instructions, such as mailing or faxing the form to the designated address.

Who needs varicella reporting form Colorado?

The varicella reporting form Colorado is typically required to be filled out by healthcare providers, including doctors, nurses, and other medical professionals, who diagnose patients with varicella within the state. This form helps the Colorado Department of Public Health and Environment monitor the incidence and spread of varicella, and facilitates the collection of important data for public health purposes. Failure to report varicella cases as required by law can result in penalties or legal consequences for healthcare providers.

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What is varicella reporting form colorado?

Varicella reporting form in Colorado is a document used to report cases of varicella infection (also known as chickenpox) to the state health department.

Who is required to file varicella reporting form colorado?

Healthcare providers, hospitals, and laboratories are required to file varicella reporting form in Colorado.

How to fill out varicella reporting form colorado?

Varicella reporting form in Colorado can be filled out online or submitted via mail with information such as patient demographics, symptoms, and test results.

What is the purpose of varicella reporting form colorado?

The purpose of varicella reporting form in Colorado is to track and monitor cases of chickenpox in the state for public health surveillance and prevention.

What information must be reported on varicella reporting form colorado?

Information such as patient demographics, symptoms, vaccination history, test results, and healthcare provider information must be reported on varicella reporting form in Colorado.