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New Hampshire Confidential COVID-19 Case Report Form v 4/08/2021 For Reporting Suspect and Confirmed Cases New diagnosis Report Date: ___/___/___hospitalization or death of previously confirmed patientPatient
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The www.dhhs.nh.gov/documents/hcv-reporting/new-hampshire-confidential-hepatitis is a reporting form used in New Hampshire to confidentially document cases of hepatitis C.
Healthcare providers and laboratories that diagnose or treat individuals with hepatitis C in New Hampshire are required to file the report.
To fill out the form, gather all necessary patient information, complete each section accurately, and submit it according to the guidelines provided by the New Hampshire Department of Health and Human Services.
The purpose is to monitor and control the spread of hepatitis C, ensure proper public health responses, and provide care to affected individuals.
Information such as patient demographics, clinical details, laboratory results, and treatment information must be reported.
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