Get the free C-12 Texas Hansen's Disease Surveillance From and Case Report

TEXAS HANSEN DISEASE PROGRAM SURVEILLANCE FORM AND TEXAS CASE REPORT Fill out all surveillance data and patient information, and send to the Texas Department of State Health Services (DSS) within

How to fill out c-12 texas hansens disease

How to fill out c-12 texas hansens disease

1. Obtain the C-12 Texas Hansens Disease form from the Texas Department of State Health Services website or request a copy from a healthcare provider.
2. Fill out the patient's personal information, including name, address, date of birth, and contact information.
3. Provide details about the patient's medical history and symptoms related to Hansen's disease.
4. Include any relevant laboratory test results or diagnostic imaging reports.
5. Sign and date the form, and make sure all information is complete and accurate before submitting.

Who needs c-12 texas hansens disease?

1. Individuals who have been diagnosed with Hansen's disease
2. Healthcare providers treating patients with Hansen's disease
3. Officials at the Texas Department of State Health Services

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What is c-12 texas hansens disease?

The C-12 Texas Hansens Disease form is a report that must be filed by healthcare providers in Texas to report cases of Hansens disease (leprosy) to the Texas Department of State Health Services.

Who is required to file c-12 texas hansens disease?

Healthcare providers in Texas are required to file the C-12 Texas Hansens Disease form if they diagnose a case of Hansens disease.

How to fill out c-12 texas hansens disease?

The C-12 Texas Hansens Disease form can be filled out online or submitted in paper form. Healthcare providers must provide information about the patient's demographics, symptoms, diagnosis, and treatment.

What is the purpose of c-12 texas hansens disease?

The purpose of the C-12 Texas Hansens Disease form is to track and monitor cases of Hansens disease in Texas in order to prevent the spread of the disease.

What information must be reported on c-12 texas hansens disease?

Healthcare providers must report information about the patient's demographics, symptoms, diagnosis, treatment, and any potential contacts who may have been exposed to the disease.