Get the free Syphilis enhanced surveillance form v13.0. Syphilis

Acute Infectious Syphilis Enhanced Form v13.0 (July 2018) CONFIDENTIAL CIDR Event ID: Section A: Patient Identifiers Patient FirstnamePatient SurnamePatient Clinic/Practice Name/Service Lab specimen

How to fill out syphilis enhanced surveillance form

How to fill out syphilis enhanced surveillance form

1. Begin by gathering all the necessary information required to fill out the syphilis enhanced surveillance form. This includes the patient's personal details such as name, date of birth, and contact information.
2. Fill out the demographics section of the form, which includes information about the patient's gender, ethnicity, and other relevant factors.
3. Provide a detailed history of the patient's syphilis infection, including the date of diagnosis, any treatment received, and the stage of the infection.
4. Fill out the section of the form that pertains to the patient's sexual history, including information about their sexual partners, condom use, and previous sexually transmitted infections.
5. If applicable, provide information about the patient's pregnancy status and any potential risks to the unborn child.
6. Fill out the laboratory testing section of the form, indicating the type of tests performed, the results, and any follow-up actions taken.
7. Review the completed form for accuracy and completeness before submitting it to the appropriate authorities.
8. Keep a copy of the form for your records and for future reference if needed.

Who needs syphilis enhanced surveillance form?

1. Healthcare professionals involved in the screening, diagnosis, and treatment of individuals with syphilis.
2. Public health agencies responsible for monitoring and tracking syphilis cases.
3. Research institutions conducting studies on syphilis and its epidemiology.
4. Any individual or organization interested in contributing to syphilis surveillance efforts.

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What is syphilis enhanced surveillance form?

The syphilis enhanced surveillance form is a document used to collect detailed information about syphilis cases for tracking and monitoring purposes.

Who is required to file syphilis enhanced surveillance form?

Healthcare providers and laboratories are required to file the syphilis enhanced surveillance form.

How to fill out syphilis enhanced surveillance form?

The syphilis enhanced surveillance form should be filled out with detailed information about the syphilis case, including demographics, symptoms, treatment, and follow-up.

What is the purpose of syphilis enhanced surveillance form?

The purpose of the syphilis enhanced surveillance form is to track and monitor syphilis cases for public health purposes.

What information must be reported on syphilis enhanced surveillance form?

Information such as patient demographics, symptoms, treatment history, and follow-up care must be reported on the syphilis enhanced surveillance form.