Get the free KDHE Influenza Virus Specimen Submission Form - kdheks
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This form is used for submitting influenza virus specimens from hospitalized patients and ILI cases to the Kansas Health and Environmental Laboratories. It includes sections for facility information,
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How to fill out kdhe influenza virus specimen
How to fill out KDHE Influenza Virus Specimen Submission Form
01
Obtain the KDHE Influenza Virus Specimen Submission Form from the KDHE website or local health department.
02
Fill in the patient's demographic information, including name, date of birth, and contact details.
03
Provide the healthcare provider's information, including name, phone number, and facility.
04
Indicate the specimen type (e.g., nasal swab, throat swab) and the collection date.
05
Complete the clinical information section, including symptoms and duration of illness.
06
Check the boxes to indicate if the specimen is for surveillance, outbreak investigation, or other purposes.
07
Sign and date the form as required, and include any additional notes if necessary.
08
Submit the completed form along with the specimen to the designated KDHE laboratory.
Who needs KDHE Influenza Virus Specimen Submission Form?
01
Healthcare providers collecting respiratory specimens for influenza testing.
02
Clinics and hospitals involved in influenza surveillance.
03
Public health officials managing outbreaks or monitoring influenza activity.
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What is KDHE Influenza Virus Specimen Submission Form?
The KDHE Influenza Virus Specimen Submission Form is a document used by healthcare providers to submit specimens of suspected influenza cases to the Kansas Department of Health and Environment for diagnostic testing.
Who is required to file KDHE Influenza Virus Specimen Submission Form?
Healthcare providers, including doctors and laboratories, that suspect a patient has influenza and wish to submit specimens for testing are required to file the KDHE Influenza Virus Specimen Submission Form.
How to fill out KDHE Influenza Virus Specimen Submission Form?
To fill out the KDHE Influenza Virus Specimen Submission Form, provide patient demographic information, details of the specimen submitted, clinical symptoms, and the healthcare provider's contact information. Ensure all required fields are completed accurately.
What is the purpose of KDHE Influenza Virus Specimen Submission Form?
The purpose of the KDHE Influenza Virus Specimen Submission Form is to facilitate the collection and testing of influenza specimens, which helps in monitoring and controlling influenza outbreaks, as well as providing data for public health responses.
What information must be reported on KDHE Influenza Virus Specimen Submission Form?
The form must report patient identity, date of specimen collection, type of specimen, symptoms experienced, and additional medical history relevant to influenza infection.
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