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LYME DISEASE CASE REPORT Please complete the following information for individuals who have or may have Lyme disease. FAX completed form to: 6139661813 (Confidential) or EMAIL to CDCFax1@hpeph.ca

How to fill out lyme disease reporting form

How to fill out lyme disease reporting form

1. To fill out a Lyme disease reporting form, follow these steps:
2. Step 1: Obtain the Lyme disease reporting form from the appropriate healthcare or public health authority.
3. Step 2: Provide your personal information such as name, contact details, and date of birth.
4. Step 3: Describe your symptoms and the date of onset.
5. Step 4: Provide details about your potential exposure to Lyme disease, such as the location and date of a tick bite.
6. Step 5: If available, include any laboratory test results related to Lyme disease.
7. Step 6: Sign and date the form, acknowledging that the information provided is accurate to the best of your knowledge.
8. Step 7: Submit the completed Lyme disease reporting form to the designated healthcare or public health authority.

Who needs lyme disease reporting form?

1. Anyone who has been diagnosed with Lyme disease or suspects they may have Lyme disease should fill out a Lyme disease reporting form. Healthcare professionals, laboratories, and public health authorities also require this form to track and monitor cases of Lyme disease.

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What is lyme disease reporting form?

The Lyme disease reporting form is a document used to report cases of Lyme disease to the appropriate health authorities.

Who is required to file lyme disease reporting form?

Healthcare providers, laboratories, and other entities are required to file the Lyme disease reporting form when they diagnose or identify a case of Lyme disease.

How to fill out lyme disease reporting form?

The Lyme disease reporting form is typically filled out by providing information such as patient demographics, symptoms, date of diagnosis, and possible sources of infection.

What is the purpose of lyme disease reporting form?

The purpose of the Lyme disease reporting form is to track and monitor cases of Lyme disease in order to better understand the spread of the disease and to implement appropriate prevention measures.

What information must be reported on lyme disease reporting form?

Information that must be reported on the Lyme disease reporting form includes patient demographics, symptoms, date of diagnosis, and possible sources of infection.