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Appendix 103Mumps Surveillance Worksheet
Name (Last, First)Hospital Record NumberAddress (Street and Number)City PID11.3County PID11.9Reporting Physician/Nurse/Hospital/Clinic/LabStatePID11.4Zip Code
PID11.5PhoneAddressPhone
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How to fill out mumps surveillance worksheet-appendix 10-3
01
To fill out the mumps surveillance worksheet-appendix 10-3, follow the steps below:
02
Begin by entering the date of the report in the designated field.
03
Enter the name of the facility or organization in the appropriate section.
04
Provide information about the individual being reported, including their name, date of birth, and gender.
05
Fill in the details of the mumps case, such as the date of onset, symptoms experienced, and any laboratory confirmation.
06
Indicate any necessary follow-up actions, such as isolation or treatment.
07
Include additional comments or notes as needed.
08
Finally, sign and date the worksheet to validate the information provided.
09
Ensure that all information is accurately and comprehensively filled out before submitting the worksheet.
Who needs mumps surveillance worksheet-appendix 10-3?
01
The mumps surveillance worksheet-appendix 10-3 is needed by healthcare facilities, organizations, and individuals responsible for monitoring and reporting mumps cases.
02
It is essential for epidemiologists, public health officials, healthcare providers, and other stakeholders involved in mumps surveillance and control.
03
The worksheet helps track and document mumps cases, aiding in the identification of outbreaks, analysis of trends, and implementation of appropriate control measures.
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What is mumps surveillance worksheet-appendix 10-3?
The mumps surveillance worksheet-appendix 10-3 is a document used for tracking and reporting cases of mumps, collected by public health authorities to monitor the incidence and spread of the disease.
Who is required to file mumps surveillance worksheet-appendix 10-3?
Healthcare providers and facilities that diagnose or treat mumps cases are required to file the mumps surveillance worksheet-appendix 10-3 with the relevant public health department.
How to fill out mumps surveillance worksheet-appendix 10-3?
To fill out the worksheet, providers must provide accurate patient information, including demographics, vaccination history, clinical presentation, and laboratory results, ensuring all required fields are completed.
What is the purpose of mumps surveillance worksheet-appendix 10-3?
The purpose of the mumps surveillance worksheet-appendix 10-3 is to collect and analyze data on mumps cases to help inform public health responses, vaccination campaigns, and policy decisions.
What information must be reported on mumps surveillance worksheet-appendix 10-3?
Informational fields include patient's name, date of birth, address, vaccination status, symptoms, laboratory confirmation, and any relevant epidemiological links.
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