Get the free Pertussis, P-00637 - Wisconsin Department of Health Services
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Location: ___ Completed by: ___Pertussis Close Contact Investigation Worksheet Index Case Name: ___ Name:Hospitalized? DOB:Pregnant? Gender: MaleFemaleRelation to case:N Any cough? Enough onset date:___Immunocompromised?
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How to fill out pertussis p-00637 - wisconsin
How to fill out pertussis p-00637 - wisconsin
01
Obtain a copy of the pertussis P-00637 form from the Wisconsin Department of Health Services.
02
Fill out the patient information section with the individual's full name, date of birth, and contact information.
03
Provide details about the patient's medical history and any known allergies.
04
Complete the vaccination history section, including dates and types of pertussis vaccines received.
05
Sign and date the form, along with any required healthcare provider information.
06
Submit the completed form to the appropriate healthcare provider or public health department.
Who needs pertussis p-00637 - wisconsin?
01
Individuals in Wisconsin who require immunization records for pertussis or individuals who have been diagnosed or suspected of having pertussis may need to fill out the pertussis P-00637 form.
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What is pertussis p-00637 - wisconsin?
Pertussis p-00637 - wisconsin is a form used to report cases of pertussis in the state of Wisconsin.
Who is required to file pertussis p-00637 - wisconsin?
Healthcare providers and laboratories are required to file pertussis p-00637 - wisconsin.
How to fill out pertussis p-00637 - wisconsin?
Pertussis p-00637 - wisconsin should be filled out with information about the confirmed cases of pertussis, including patient demographics and test results.
What is the purpose of pertussis p-00637 - wisconsin?
The purpose of pertussis p-00637 - wisconsin is to track and monitor cases of pertussis in Wisconsin for public health surveillance.
What information must be reported on pertussis p-00637 - wisconsin?
Information reported on pertussis p-00637 - wisconsin includes patient demographics, test results, and vaccination history.
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