Get the free hcp and shigellosis form - doh wa

LHJ Use ID Reported to DOH Date // LHJ Classification Confirmed Probable By Lab Clinical Epi Link Shigellosis County REPORT SOURCE LHJ notification date // Investigation start date // Reporter check all that apply Hospital HCP Public health agency Other Outbreak-related LHJ Cluster LHJ Cluster Name DOH Outbreak Reporter name Reporter phone Primary HCP name OK to talk to case Yes No DK Primary HCP phone Date of interview // PATIENT INFORMATION Nam...

How to fill out hcp and shigellosis form

How to fill out hcp and shigellosis form:

1. Obtain the hcp and shigellosis form from the appropriate source or healthcare provider.
2. Read the instructions on the form carefully to understand the information required.
3. Begin by providing your personal details such as name, date of birth, and contact information.
4. Fill in any specific details related to your healthcare provider, such as their name, address, and contact information.
5. Provide a detailed medical history, including any previous diagnoses, medications, treatments, and surgeries.
6. Answer questions related to symptoms you may be experiencing, such as fever, diarrhea, or abdominal pain.
7. If applicable, disclose any recent travel history, especially to regions known for shigellosis outbreaks.
8. Include information about any known exposure to shigellosis or contact with infected individuals.
9. Indicate if you have been tested for shigellosis and provide details of the test results if available.
10. Review the completed form for accuracy and completeness.
11. Sign and date the form as required.

Who needs hcp and shigellosis form:

1. Individuals who have been diagnosed with shigellosis or are experiencing symptoms associated with the infection may be required to fill out the hcp and shigellosis form.
2. Healthcare providers, including doctors, nurses, and other medical professionals, may need the form to properly assess and track cases of shigellosis.
3. Public health officials and organizations conducting surveillance and monitoring of shigellosis cases may also require individuals to complete the form to gather necessary data for reporting and prevention efforts.

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What is hcp and shigellosis form?

The hcp and shigellosis form is a document used to report cases of shigellosis, a bacterial infection that causes diarrhea and abdominal pain, to the designated health authorities.

Who is required to file hcp and shigellosis form?

Healthcare providers, such as doctors and hospitals, are required to file the hcp and shigellosis form when they diagnose a case of shigellosis.

How to fill out hcp and shigellosis form?

To fill out the hcp and shigellosis form, healthcare providers need to provide information about the patient's demographics, symptoms, onset of illness, laboratory test results, and any relevant travel or contact history.

What is the purpose of hcp and shigellosis form?

The purpose of the hcp and shigellosis form is to track and monitor cases of shigellosis in order to prevent further spread of the infection and to gather epidemiological data for public health purposes.

What information must be reported on hcp and shigellosis form?

The hcp and shigellosis form requires reporting of the patient's name, age, gender, address, contact information, symptoms, onset date, laboratory test results, travel history, and any known contact with other individuals who have shigellosis.