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Illinois Department of Public Health Division of Food, Drugs and DairiesFOOD SERVICE SANITATION MANAGER CERTIFICATION PROGRAM REQUEST FORM CURRENT INFORMATION (PLEASE TYPE/PRINT)Mr. Ms. Miss Mrs.
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How to fill out congenital heart disease screening

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How to fill out congenital heart disease screening

01
Step 1: Obtain the congenital heart disease screening form from a healthcare provider or download it online.
02
Step 2: Begin by providing your personal information, including your name, date of birth, and contact information.
03
Step 3: Answer the medical history questions related to congenital heart disease or any other relevant heart conditions in your family.
04
Step 4: Complete the questionnaire regarding your own medical history, including any known heart conditions or symptoms.
05
Step 5: If applicable, include information about any previous diagnostic tests or surgeries related to your heart and provide the necessary documentation.
06
Step 6: Review the completed form to ensure all sections are filled out accurately and thoroughly.
07
Step 7: Submit the filled-out form to your healthcare provider or the designated medical facility responsible for congenital heart disease screening.

Who needs congenital heart disease screening?

01
Congenital heart disease screening is typically recommended for infants, children, and adults with a family history of heart conditions.
02
It is also recommended for individuals who exhibit symptoms or signs of potential heart problems, such as breathing difficulties, poor growth, or abnormal heart murmurs.
03
Furthermore, people with certain genetic disorders or other medical conditions that increase the risk of congenital heart disease may also need screening.
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Congenital heart disease screening is a test that helps detect heart problems in infants before they are born.
Healthcare providers are required to file congenital heart disease screening for newborns.
Congenital heart disease screening can be filled out by healthcare providers during routine checkups for newborns.
The purpose of congenital heart disease screening is to identify heart defects early so that treatment can be started promptly.
Information such as family history of heart disease, prenatal exposure to certain medications or infections, and any abnormal prenatal ultrasounds must be reported on congenital heart disease screening.
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