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Congenital Syphilis Surveillance Form v4.0 (July 2019) CONFIDENTIAL Page 1 of 2CIDR Event ID: Section A: Patient (Child) Information 1. Patients Hospital No.:2. Hospital Name:3. Forename: 4. Surname:

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How to fill out use of national syphilis

01

Obtain the national syphilis form from the appropriate healthcare authority.

02

Provide personal information such as name, date of birth, and address.

03

Answer all the questions related to the diagnosis, treatment, and history of syphilis.

04

Fill out the details of any previous treatments received for syphilis.

05

Include the dates and results of any syphilis tests done in the past.

06

If applicable, provide information on sexual partners and their contact details.

07

Sign and date the form to certify that the information provided is accurate.

08

Submit the completed form to the designated healthcare authority.

Who needs use of national syphilis?

01

Anyone who is diagnosed with syphilis or suspects they may have syphilis needs to fill out the national syphilis form.

02

Healthcare professionals who are responsible for diagnosing and treating syphilis may also need to use the national syphilis form to track cases and gather important information.

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What is use of national syphilis?

The use of national syphilis refers to standardized methods and guidelines for tracking syphilis cases and related healthcare data across a nation.

Who is required to file use of national syphilis?

Healthcare providers, laboratories, and public health officials involved in diagnosing and managing syphilis cases are required to file use of national syphilis data.

How to fill out use of national syphilis?

To fill out the use of national syphilis, healthcare providers should gather the necessary patient information, complete the designated forms accurately, and submit them to the appropriate public health department.

What is the purpose of use of national syphilis?

The purpose of use of national syphilis is to monitor syphilis trends, facilitate public health responses, and improve prevention and treatment strategies.

What information must be reported on use of national syphilis?

Information that must be reported includes patient demographics, test results, treatment details, and any other relevant clinical information related to syphilis cases.

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