Get the free MONKEYPOX CONTACT SURVEILLANCE FORM - publichealth lacounty

MONEYBOX CONTACT SURVEILLANCE FORM Acute Communicable Disease Control 313 N. Figueroa St., Rm. 212 Los Angeles, CA 90012 2132407941 (phone), 2134824856 (facsimile) publichealth.lacounty.gov/acd/Investigator

How to fill out monkeypox contact surveillance form

How to fill out monkeypox contact surveillance form

1. To fill out the monkeypox contact surveillance form, follow these steps:
2. Start by providing your personal information such as name, contact information, and identification details.
3. Indicate whether you are the primary contact or a secondary contact.
4. Specify the relationship you have with the suspected or confirmed monkeypox case.
5. Provide details about your exposure to the infected individual, including the date and duration of contact.
6. Answer questions regarding symptoms you may have experienced, such as fever, rash, or other noticeable changes in health.
7. Share any additional relevant information or concerns in the designated section.
8. Submit the completed form to the appropriate healthcare or public health authority for processing and monitoring.

Who needs monkeypox contact surveillance form?

1. Anyone who has been in contact with a suspected or confirmed case of monkeypox needs to complete the monkeypox contact surveillance form. This includes both primary contacts, who had direct contact with the infected individual, and secondary contacts, who had exposure to the primary contacts. The form helps track the potential spread of the virus and facilitates monitoring of individuals for any symptoms or signs of infection.

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What is monkeypox contact surveillance form?

The monkeypox contact surveillance form is a document used to track and monitor individuals who have come into contact with someone infected with monkeypox.

Who is required to file monkeypox contact surveillance form?

Healthcare professionals, public health officials, and anyone responsible for monitoring individuals exposed to monkeypox are required to file the form.

How to fill out monkeypox contact surveillance form?

The form typically requires information such as the contact's personal details, date and nature of exposure, symptoms if any, and follow-up actions taken.

What is the purpose of monkeypox contact surveillance form?

The purpose of the form is to ensure timely and appropriate monitoring of individuals who may have been exposed to monkeypox in order to prevent further spread of the disease.

What information must be reported on monkeypox contact surveillance form?

Information such as contact's personal details, date and nature of exposure, symptoms if any, and follow-up actions taken must be reported on the form.