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Zoonotic Control BranchChikungunya, Dengue, and Zika Testing Supplemental Information PLEASE PRINT CLEARLY AND COMPLETE ALL SECTIONS. This information is REQUIRED prior to testing. This form should
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To fill out the forms for chikungunya, dengue, and zika, follow these steps:
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Collect all necessary information and documents such as personal details, travel history, symptoms, and test results.
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Prepare a clean and legible form to fill in the information.
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Start by providing your personal information, including full name, contact details, and date of birth.
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Next, provide details about your recent travel history, including the countries visited and the duration of stay.
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List any symptoms you have experienced, such as fever, joint pain, rash, headache, etc.
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If you have undergone any diagnostic tests for chikungunya, dengue, or zika, provide the test results and the date of testing.
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Who needs chikungunya dengue and zika?

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Anyone who suspects they may have contracted chikungunya, dengue, or zika needs to be aware of the diseases and seek medical attention.
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Primary beneficiaries for information related to chikungunya, dengue, and zika include:
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- Individuals who have recently traveled to regions endemic with these diseases
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It is essential for these individuals to stay informed about the symptoms, prevention methods, and testing procedures for chikungunya, dengue, and zika.
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Chikungunya, dengue, and Zika are mosquito-borne viral infections that can cause fever, rashes, and joint pain. They are transmitted primarily by Aedes mosquitoes.
Individuals who are diagnosed with chikungunya, dengue, or Zika, as well as healthcare providers, are typically required to report these cases to public health authorities.
Filling out forms for chikungunya, dengue, and Zika usually involves providing patient information, symptoms, diagnosis, treatment, and travel history on the prescribed reporting forms.
The purpose of reporting chikungunya, dengue, and Zika is to monitor and control outbreaks, gather epidemiological data, and implement public health interventions.
The report must include patient demographics, clinical symptoms, laboratory results, vaccination status, and travel history to areas where these diseases are prevalent.
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