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DEPARTMENT OF HEALTH SERVICES Division of Public Health F05280 (Rev. 05/2018)STATE OF WISCONSIN Wis. Stat. 69.21-Page 1 of 2WISCONSIN DEATH CERTIFICATE APPLICATIONTYPE or PRINT.(for Mail or Unperson

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How to fill out influenza disease fact sheet

01

To fill out the influenza disease fact sheet, follow these steps:

02

Start by providing basic information such as the date and your name.

03

Indicate the type of influenza you are reporting on, whether it's seasonal influenza or a specific strain like H1N1.

04

Include details about the affected individual, such as their age, gender, and any pre-existing medical conditions.

05

Note the symptoms experienced by the individual, such as fever, cough, sore throat, body aches, and fatigue.

06

Specify the date of symptom onset and any relevant dates for medical visits or tests.

07

Provide information about the individual's vaccination history, including the date of the last influenza vaccination if available.

08

Include any information about potential contacts with other individuals who may have had influenza.

09

Mention any complications or hospitalizations resulting from the illness.

10

Lastly, sign and date the fact sheet to certify its accuracy.

Who needs influenza disease fact sheet?

01

The influenza disease fact sheet is useful for various individuals and organizations, including:

02

- Healthcare professionals who are responsible for monitoring and tracking influenza cases.

03

- Public health departments and agencies that require up-to-date information on influenza activity.

04

- Researchers studying the epidemiology and impact of influenza.

05

- Educational institutions to keep track of influenza cases among students and staff.

06

- Employers who want to assess the impact of influenza on the workforce.

07

- Individuals who have been diagnosed with influenza and want to document their illness for personal or legal purposes.

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What is influenza disease fact sheet?

The influenza disease fact sheet is a document that provides information about the flu virus, its symptoms, prevention, and treatment.

Who is required to file influenza disease fact sheet?

Healthcare facilities and providers are required to file the influenza disease fact sheet.

How to fill out influenza disease fact sheet?

The influenza disease fact sheet can be filled out online or manually by providing relevant information about the influenza cases.

What is the purpose of influenza disease fact sheet?

The purpose of the influenza disease fact sheet is to track and monitor the spread of the flu virus and its impact on public health.

What information must be reported on influenza disease fact sheet?

Information such as number of confirmed cases, age groups affected, symptoms, and treatments must be reported on the influenza disease fact sheet.

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