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HSE Area Use Only Measles Enhanced Surveillance Form Phone Patient Name Address (This section is for HSE Area use only and should not be sent to HHSC) PATIENT DETAILS Initials ID No. Sex: M F DOB

How to fill out measles enhanced surveillance form

How to fill out the measles enhanced surveillance form:

1. Begin by carefully reading the instructions provided with the form. Make sure you understand the purpose and requirements of the form.
2. Fill in your personal information accurately. This includes your full name, contact information, and any other required details such as age, gender, and occupation.
3. Provide information about your vaccination history. Indicate if you have received the measles vaccine and provide the dates of immunization if possible. If you have not been vaccinated, indicate the reason why.
4. If applicable, provide information about any previous episodes of measles you may have had. Include dates, symptoms, and any medical intervention received.
5. In the section regarding recent travel, indicate if you have visited any regions or countries with known measles outbreaks. Provide the dates of travel and details about your accommodation.
6. Note any potential measles exposures you may have had. This includes close contact with individuals diagnosed with measles or exposure to settings where measles transmission may have occurred.
7. If you are a healthcare provider, provide additional information such as the number of suspected or confirmed measles cases you have encountered, laboratory testing details, and any outbreak investigation involvement.
8. Double-check all the information you have provided before submitting the form. Ensure everything is filled out accurately and truthfully.
9. Submit the completed measles enhanced surveillance form through the designated channels or to the appropriate health authorities.

Who needs the measles enhanced surveillance form:

1. The measles enhanced surveillance form is typically required for individuals suspected or confirmed to have measles. This includes individuals exhibiting symptoms indicative of measles or those who have tested positive for the measles virus.
2. Healthcare providers involved in the diagnosis, treatment, or investigation of measles cases may also need to complete the measles enhanced surveillance form. This helps authorities monitor and control the spread of measles within the community.
3. Certain settings, such as schools, childcare centers, or healthcare facilities, may require individuals with suspected or confirmed measles cases to fill out the form. This enables them to track and implement necessary measures to prevent further transmission.

For pdfFiller’s FAQs

What is measles enhanced surveillance form?

The measles enhanced surveillance form is a document used to collect detailed information on suspected and confirmed cases of measles.

Who is required to file measles enhanced surveillance form?

Healthcare providers, laboratories, and public health agencies are required to file the measles enhanced surveillance form.

How to fill out measles enhanced surveillance form?

The measles enhanced surveillance form can be filled out electronically or manually, with detailed information on the case, including symptoms, travel history, and vaccination status.

What is the purpose of measles enhanced surveillance form?

The purpose of the measles enhanced surveillance form is to track and monitor measles cases, identify outbreaks, and prevent the spread of the disease.

What information must be reported on measles enhanced surveillance form?

Information such as patient demographics, symptoms, vaccination history, and travel history must be reported on the measles enhanced surveillance form.

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