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REPORTING FORM FOR OUTBREAKS OF SUSPECTED OR CONFIRMED INFLUENZA IN LONG TERM CARE FACILITIESGeneral InformationTodays Date ___/___/___ Primary contact person for epidemiologic investigation ___ Telephone
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How to fill out long-term-care-outbreak-report-form

01
Obtain a copy of the long-term care outbreak report form from the relevant healthcare authority.
02
Fill out the basic information section, including the name of the facility, address, contact information, and date of the outbreak.
03
Provide details about the outbreak, such as the number of residents affected, symptoms exhibited, and any laboratory confirmed cases.
04
Include information about control measures implemented, such as isolation protocols, infection control procedures, and communication strategies.
05
Submit the completed form to the appropriate healthcare agency as per their guidelines.

Who needs long-term-care-outbreak-report-form?

01
Long-term care facilities, such as nursing homes, assisted living facilities, and rehabilitation centers, need the long-term care outbreak report form to report and document outbreaks of infectious diseases among their residents.

What is Long-Term-Care-Outbreak-Report-- - dhhs ne Form?

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The long-term-care-outbreak-report-form is a document used by long-term care facilities to report outbreaks of infectious diseases among residents and staff to relevant health authorities.
Long-term care facilities, including nursing homes and assisted living facilities, are required to file the long-term-care-outbreak-report-form when an outbreak occurs.
To fill out the long-term-care-outbreak-report-form, you need to provide detailed information about the outbreak, including the type of infection, number of affected individuals, date of onset, and infection control measures taken.
The purpose of the long-term-care-outbreak-report-form is to facilitate the timely reporting and tracking of outbreaks, enabling health authorities to respond effectively and monitor public health.
Information that must be reported includes the facility's name and address, outbreak details such as infection type, number of cases, affected populations, dates of the outbreak, and response actions taken.
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