Get the free Pertussis Surveillance Worksheet

Patients Name: Address: Street City State Zip Date of Birth: / / Phone: Referred by: MTV / DT / Yr Email Address: HIPAA Acknowledgement acknowledge that the Notice of Health Information Privacy Practices

How to fill out pertussis surveillance worksheet

How to fill out pertussis surveillance worksheet

1. Start by gathering all the necessary information for the pertussis surveillance worksheet, such as patient demographics, medical history, and laboratory test results.
2. Fill in the patient's personal information, including their name, date of birth, and contact information.
3. Record the date of symptom onset and the patient's current symptoms.
4. Document any previous vaccinations the patient has received for pertussis.
5. Include information about any healthcare visits the patient has made related to their symptoms.
6. Note any laboratory tests performed and their results.
7. Provide additional information, such as the date of diagnosis and the name of the healthcare provider who made the diagnosis.
8. Review the completed worksheet for accuracy and ensure all relevant information has been included.
9. Store the pertussis surveillance worksheet securely as per your organization's data protection policies.

Who needs pertussis surveillance worksheet?

1. Healthcare providers
2. Public health agencies
3. Epidemiologists
4. Researchers
5. Infection control specialists

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What is pertussis surveillance worksheet?

The pertussis surveillance worksheet is a tool used to track and monitor cases of pertussis, also known as whooping cough.

Who is required to file pertussis surveillance worksheet?

Healthcare providers and facilities are required to file pertussis surveillance worksheet in order to report cases of pertussis to the appropriate authorities.

How to fill out pertussis surveillance worksheet?

The pertussis surveillance worksheet should be filled out with information about the patient, including symptoms, test results, and treatment received.

What is the purpose of pertussis surveillance worksheet?

The purpose of pertussis surveillance worksheet is to help track and monitor the spread of pertussis in a community, and to ensure that appropriate public health interventions are taken.

What information must be reported on pertussis surveillance worksheet?

Information such as patient demographics, symptoms, test results, and treatment received must be reported on pertussis surveillance worksheet.