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Name Current Address Hospital Record Number LAST / FIRST / MIDDLE NUMBER CITY / Telephone: Home Appendix 19 VARICELLA DEATH INVESTIGATION WORKSHEET For Local Use Only / STREET / Reporting Physician/
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How to fill out varicella death investigation worksheet
How to fill out a varicella death investigation worksheet:
01
Begin by gathering all relevant information about the patient, such as their name, age, and medical history.
02
Document the date and time of the patient's death.
03
Specify the symptoms the patient experienced leading up to their death and any signs of varicella infection.
04
Include information about the patient's vaccination history and whether they received the varicella vaccine.
05
Provide details about any medical interventions or treatments the patient received.
06
Describe the laboratory tests conducted on the patient, such as varicella antibody tests or viral culture.
07
Explain any additional investigations performed, such as autopsies or consultations with specialists.
08
Document the final diagnosis and underlying cause of death, if determined.
09
Include any recommendations or preventive measures suggested based on the investigation.
10
Review the completed worksheet for accuracy and completeness before submitting it to the appropriate authorities.
Who needs a varicella death investigation worksheet?
A varicella death investigation worksheet is typically required by public health authorities, medical examiners, or coroners who are responsible for investigating and tracking cases of varicella-related deaths. This worksheet helps in documenting vital information about the patient, understanding the circumstances surrounding their death, and identifying any potential public health concerns or preventive measures that need to be implemented. It serves as an important tool in ensuring accurate reporting and surveillance of varicella-related fatalities.
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What is varicella death investigation worksheet?
The varicella death investigation worksheet is a form used to collect information about a death related to varicella (chickenpox) in order to improve understanding of the disease and prevent future deaths.
Who is required to file varicella death investigation worksheet?
Healthcare providers, medical examiners, and coroners are required to file varicella death investigation worksheets when a death related to varicella occurs.
How to fill out varicella death investigation worksheet?
The worksheet should be completed by providing detailed information about the deceased individual, medical history, symptoms, treatment, and other relevant details related to varicella infection and death.
What is the purpose of varicella death investigation worksheet?
The purpose of the worksheet is to collect data that can be used to analyze trends, identify risk factors, and develop strategies to prevent future varicella-related deaths.
What information must be reported on varicella death investigation worksheet?
Information such as the patient's demographics, medical history, symptoms, treatment, complications, and circumstances surrounding the death must be reported on the worksheet.
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