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Gonorrhea Surveillance Form
Version 1.2 03/07/2018CONFIDENTIAL
For office use only: CIDR Event Midsection A: Patient information
2. Clinic/Practice Name/Service:1. Patient Clinic ID:
3. Patient First
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How to fill out gonorrhoea surveillance form gonorrhoea
How to fill out gonorrhoea surveillance form gonorrhoea
01
Obtain the gonorrhoea surveillance form from the appropriate public health department or organization.
02
Fill out the patient information section including name, date of birth, and contact information.
03
Provide details about the gonorrhoea diagnosis including date of diagnosis, symptoms, and any treatment received.
04
Include information about the healthcare provider who made the diagnosis and any relevant laboratory test results.
05
Submit the completed form to the designated public health authority according to their reporting guidelines.
Who needs gonorrhoea surveillance form gonorrhoea?
01
Healthcare providers who diagnose or treat patients with gonorrhoea are required to fill out the gonorrhoea surveillance form.
02
Public health departments or organizations responsible for monitoring and tracking infectious diseases also need this information for surveillance purposes.
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What is gonorrhoea surveillance form gonorrhoea?
Gonorrhoea surveillance form is a form used to track and monitor cases of gonorrhoea.
Who is required to file gonorrhoea surveillance form gonorrhoea?
Healthcare providers, laboratories, and public health departments are required to file gonorrhoea surveillance form.
How to fill out gonorrhoea surveillance form gonorrhoea?
Gonorrhoea surveillance form can be filled out by providing patient information, test results, and treatment details.
What is the purpose of gonorrhoea surveillance form gonorrhoea?
The purpose of gonorrhoea surveillance form is to track the spread of gonorrhoea, monitor treatment outcomes, and implement public health interventions.
What information must be reported on gonorrhoea surveillance form gonorrhoea?
Information such as patient demographics, testing results, treatment information, and any potential contacts must be reported on the form.
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