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Ebola Virus Disease Contact Assessment Form Version 1.1 12/01/2015 Section A Contact Information Contact of Event ID If index case diagnosed in Ireland Surname: Forename: Address: Home: Work: Sex:
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How to fill out ebola virus disease contact
How to fill out Ebola virus disease contact:
01
Begin by putting your personal information such as name, address, phone number, and email address. This is important to ensure that you can be contacted if necessary.
02
Next, provide details about your recent travel history. Specify the countries you have visited in the past few months and the dates of your visit.
03
Indicate whether you have been in contact with any person diagnosed with Ebola virus disease. If yes, provide details of the contact and their relationship to you.
04
Mention any symptoms you might be experiencing, such as fever, headache, fatigue, muscle pain, vomiting, or diarrhea.
05
Inquire about any potential exposure to bodily fluids or tissues of someone suspected or confirmed to have Ebola virus disease.
06
Finally, sign and date the form to confirm the accuracy of your information.
Who needs Ebola virus disease contact:
01
Individuals who have recently traveled to regions where Ebola virus disease is prevalent should fill out the contact form. This includes countries in West Africa, such as Guinea, Liberia, Sierra Leone, and Democratic Republic of Congo.
02
Healthcare workers who have come into contact with Ebola virus disease patients or their bodily fluids should also complete the contact form.
03
Individuals who have had close contact with someone diagnosed with Ebola virus disease should fill out the contact form to ensure appropriate monitoring and follow-up.
04
Anyone experiencing symptoms associated with Ebola virus disease, even if they have not traveled or had known contact, should seek medical attention and may be asked to complete the contact form.
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What is ebola virus disease contact?
Ebola virus disease contact refers to individuals who have been in close proximity to someone infected with the Ebola virus.
Who is required to file ebola virus disease contact?
Health authorities and medical professionals are required to report Ebola virus disease contacts.
How to fill out ebola virus disease contact?
Ebola virus disease contacts are typically recorded using a standardized form with details such as name, contact information, exposure history, and symptoms.
What is the purpose of ebola virus disease contact?
The purpose of tracking Ebola virus disease contacts is to prevent further spread of the virus by identifying and monitoring individuals who may have been exposed.
What information must be reported on ebola virus disease contact?
Information such as contact details, exposure history, symptoms, and any relevant medical history must be reported on Ebola virus disease contacts.
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