Get the free Varicella (Chickenpox) or Zoster (Shingles) Case Report Form - Minnesota Dept. of He...
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Varicella (Chickenpox) or Zoster (Shingles) Case Report Form Minnesota Child Care Centers and Homes Date reporting: To:Minnesota Department of Health, PD Surveillance Misreport all chickenpox and
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How to fill out varicella chickenpox or zoster
How to fill out varicella chickenpox or zoster
01
To fill out a varicella chickenpox or zoster form, follow these steps:
02
Start by providing your personal information such as your name, age, and contact details.
03
Specify the date of your diagnosis and the healthcare professional who diagnosed you.
04
Clearly state whether you have been diagnosed with varicella chickenpox or zoster.
05
Mention any symptoms you have experienced and provide details about their severity and duration.
06
Include information about any treatments you have received or are currently undergoing.
07
If applicable, provide details about any complications or hospitalizations related to varicella chickenpox or zoster.
08
Ensure that you sign and date the form to confirm its accuracy and authenticity.
09
Submit the completed form to the appropriate authority or healthcare provider.
Who needs varicella chickenpox or zoster?
01
Varicella chickenpox or zoster vaccination is recommended for:
02
- Children who have not been vaccinated before the age of 13
03
- Adults who have never had chickenpox or received the vaccination
04
- Individuals who have a weakened immune system
05
- Healthcare workers who have not been vaccinated or previously had chickenpox
06
- Women planning to become pregnant who are not immune to varicella
07
It is important to consult with a healthcare professional to determine if you need the varicella chickenpox or zoster vaccination based on your individual circumstances.
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What is varicella chickenpox or zoster?
Varicella, commonly known as chickenpox, is a highly contagious disease caused by the varicella-zoster virus.
Who is required to file varicella chickenpox or zoster?
Healthcare providers and public health officials are required to report cases of varicella chickenpox or zoster.
How to fill out varicella chickenpox or zoster?
Varicella chickenpox or zoster cases can be reported through electronic reporting systems or by submitting paper forms to the appropriate public health department.
What is the purpose of varicella chickenpox or zoster?
The purpose of reporting varicella chickenpox or zoster is to track and control the spread of the disease, identify outbreaks, and implement appropriate public health measures.
What information must be reported on varicella chickenpox or zoster?
Basic patient information, clinical details, laboratory test results, and vaccination history are among the information that must be reported for varicella chickenpox or zoster cases.
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