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ASSESSMENT FORM FOR MONEYBOX TESTING ERIE COUNTY DEPARTMENT OF HEALTH Suspect/Case Information(Circle One)Last Name:___ Street: ___Date of Report: ___ Ruled Out TestedFirst Name:___ DOB: ___Town/City:
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How to fill out monkeypox case investigation form

01
Step 1: Obtain the monkeypox case investigation form from the relevant health authority.
02
Step 2: Fill out the personal information section with details of the patient including name, age, gender, and contact information.
03
Step 3: Provide details of the presenting symptoms and medical history of the patient.
04
Step 4: Include information on any recent travel history or exposure to potential sources of monkeypox.
05
Step 5: Document any laboratory test results or diagnostic procedures conducted on the patient.
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Step 6: Submit the completed form to the appropriate health authorities for further investigation and monitoring.

Who needs monkeypox case investigation form?

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The monkeypox case investigation form is a document used to collect information about suspected or confirmed cases of monkeypox in order to track and prevent the spread of the disease.
Healthcare professionals, laboratories, and public health authorities are required to file monkeypox case investigation forms when a suspected or confirmed case of monkeypox is identified.
The monkeypox case investigation form typically requires information such as patient demographics, symptoms, travel history, and contacts. It is important to accurately fill out all sections of the form to ensure proper tracking and investigation of the case.
The purpose of the monkeypox case investigation form is to gather important information about suspected or confirmed cases of monkeypox in order to understand the spread of the disease and implement appropriate control measures.
The monkeypox case investigation form may require information such as patient demographics, symptoms, laboratory test results, travel history, and contact information for possible contacts.
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