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State of Connecticut Reportable Disease Confidential Case Report Form PD23 (rev. 01/01/2021)Department of Public Health 410 Capitol Avenue, MS#11FDS P.O. Box 340308 Hartford, CT 061340308For information

How to fill out reportable disease confidential case

How to fill out reportable disease confidential case

1. Step 1: Obtain a copy of the reportable disease confidential case form.
2. Step 2: Fill out the patient's personal information, such as name, date of birth, and contact information.
3. Step 3: Provide details about the disease, including onset date, symptoms experienced, and any relevant medical history.
4. Step 4: Clearly indicate the testing methods used and the results obtained.
5. Step 5: Describe any treatment received by the patient, including medications and therapies.
6. Step 6: Provide information about the healthcare facility or provider responsible for diagnosing and treating the disease.
7. Step 7: Sign and date the form to certify its accuracy.
8. Step 8: Submit the completed reportable disease confidential case form to the designated health authority or department.

Who needs reportable disease confidential case?

1. Healthcare professionals who diagnose and treat reportable diseases
2. Medical facilities and healthcare organizations
3. Public health departments and authorities

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What is reportable disease confidential case?

A reportable disease confidential case is a legally mandated report that healthcare providers must submit to public health authorities when they diagnose or suspect a reportable communicable disease, ensuring that cases are tracked while maintaining patient confidentiality.

Who is required to file reportable disease confidential case?

Healthcare providers, including physicians, hospitals, and laboratories, are typically required to file a reportable disease confidential case.

How to fill out reportable disease confidential case?

To fill out a reportable disease confidential case, providers must complete a standardized form that includes patient information, disease specifics, diagnosis date, and any relevant clinical details while ensuring the patient's identity remains confidential.

What is the purpose of reportable disease confidential case?

The purpose of a reportable disease confidential case is to monitor and control the spread of infectious diseases, facilitate public health interventions, and ensure that adequate resources are allocated for disease prevention and control.

What information must be reported on reportable disease confidential case?

Required information includes patient demographics (age, sex, contact details), diagnosis date, type of disease, symptoms, laboratory results, and any relevant risk factors.