Get the free Perinatal Hepatitis B Contact Investigation Form - PHPA

Perinatal Hepatitis B Contact Investigation Form Name of Mother : Number: Contact # 1: Demographic Information and Vaccination Record Name: Address: Phone: () DOB: / Sex: / Physician's Name: Type

How to fill out perinatal hepatitis b contact

How to fill out perinatal hepatitis B contact:

1. Obtain the necessary form: Begin by obtaining the perinatal hepatitis B contact form from your healthcare provider or the relevant authority. This form is typically used to gather information about individuals who may have come into contact with a mother diagnosed with hepatitis B during pregnancy or childbirth.
2. Gather accurate information: Ensure that you have all the required information beforehand. This includes details about the mother, such as her name, date of birth, and contact information. Also, collect information about the newborn, including their name, date of birth, and any available identification numbers.
3. Provide relevant medical information: Fill out the form by providing specific medical information related to the mother and the newborn. This may include their medical history, any known allergies, and information about any previous hepatitis B immunizations or treatments.
4. Record potential contact individuals: Identify and record all individuals who may have come into contact with the mother or newborn during the pregnancy or delivery. This typically includes healthcare professionals, family members, and close contacts. List their names, contact information, and their relationship to the mother or newborn.
5. Include contact dates: Indicate the dates of contact for each individual listed. This helps identify the period during which potential transmission of hepatitis B could have occurred.
6. Provide additional relevant details: Use any available spaces on the form to provide additional details or notes. This may include any relevant information about the potential exposure or any specific requests or precautions that need to be taken.

Who needs perinatal hepatitis B contact?

Perinatal hepatitis B contact is relevant for healthcare professionals, family members, and close contacts who have been in direct contact with a mother diagnosed with hepatitis B during pregnancy or childbirth. This includes individuals who may have administered medical care, provided support during delivery, or had significant close contact with the mother or newborn during the period of potential transmission. It is crucial to identify and notify these individuals to ensure appropriate follow-up and preventive measures against hepatitis B transmission.

For pdfFiller’s FAQs

What is perinatal hepatitis b contact?

Perinatal hepatitis B contact refers to the reporting of infants born to mothers infected with hepatitis B.

Who is required to file perinatal hepatitis b contact?

Healthcare providers and hospitals are required to file perinatal hepatitis B contact.

How to fill out perinatal hepatitis b contact?

Perinatal hepatitis B contact can be filled out online through a designated reporting portal.

What is the purpose of perinatal hepatitis b contact?

The purpose of perinatal hepatitis B contact is to monitor and track infants born to hepatitis B infected mothers for proper care and treatment.

What information must be reported on perinatal hepatitis b contact?

Information such as maternal HBsAg status, infant vaccination status, and follow-up care plans must be reported on perinatal hepatitis B contact.

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