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Arkansas Department of Health Communicable Disease Reporting Form Fax Reports to (501) 66124284815 West Markham Street, Slot #32 Little Rock, AR 72205 Please Print LegiblyReporting facility: Address:

How to fill out communicable disease reporting form

How to fill out communicable disease reporting form

1. Step 1: Obtain a communicable disease reporting form from the appropriate health department or online.
2. Step 2: Begin by providing basic information, such as the name and contact details of the person filling out the form.
3. Step 3: Indicate the name and contact information of the individual or organization reporting the communicable disease.
4. Step 4: Specify the disease being reported, including any specific details such as symptoms, duration, and diagnosis.
5. Step 5: Include the date of onset and any relevant dates related to diagnosis, hospitalization, or treatment.
6. Step 6: If applicable, provide information about any potential sources of infection or exposure.
7. Step 7: Indicate whether or not the case has been lab-confirmed and include any laboratory test results, if available.
8. Step 8: Enter any additional information or comments that may be relevant to the case.
9. Step 9: Review the completed form to ensure all information is accurate and complete.
10. Step 10: Submit the communicable disease reporting form to the appropriate health department or designated authority.

Who needs communicable disease reporting form?

1. Healthcare providers, including doctors, nurses, and other medical professionals, need the communicable disease reporting form.
2. Health departments and public health agencies also require this form for monitoring and controlling the spread of diseases within a community.
3. In some cases, individuals may be legally required to report certain communicable diseases, depending on local regulations.

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What is communicable disease reporting form?

A communicable disease reporting form is a standardized document used by healthcare providers to report cases of communicable diseases to public health authorities.

Who is required to file communicable disease reporting form?

Healthcare professionals and facilities, including doctors, nurses, and laboratories, are required to file the communicable disease reporting form when they diagnose or identify a case of a notifiable communicable disease.

How to fill out communicable disease reporting form?

To fill out the communicable disease reporting form, one must complete all required fields with accurate information about the patient, the disease, and any relevant medical history, and submit it to the appropriate public health agency.

What is the purpose of communicable disease reporting form?

The purpose of the communicable disease reporting form is to facilitate the monitoring, control, and prevention of communicable diseases by providing public health authorities with essential data on the incidence and spread of these illnesses.

What information must be reported on communicable disease reporting form?

The information that must be reported typically includes patient demographics (name, age, address), diagnosis, date of diagnosis, symptoms, and any pertinent clinical information or laboratory results.