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Patient InformationName: ___Date: ___/___/___ Address: ___ City: ___ State: ___ Zip Code: ___ Sex: ___M ___F Birthday: ___/___/___Email: ___ Daytime Phone (___) ___ May we contact you via email for
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How to fill out mumps surveillance worksheet-appendix 10-4

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How to fill out mumps surveillance worksheet-appendix 10-4

01
Gather all necessary information regarding the suspected mumps case.
02
Fill out the demographic information section including name, age, sex, and contact information.
03
Provide details on the mumps vaccination history of the individual.
04
Record the dates of symptom onset, diagnosis, and lab confirmation.
05
Include any relevant medical history and current symptoms.
06
Submit the completed worksheet to the appropriate health authority.

Who needs mumps surveillance worksheet-appendix 10-4?

01
Healthcare providers and public health officials who are investigating suspected mumps cases.

What is Mumps Surveillance Worksheet-Appendix 10-4 Form?

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The mumps surveillance worksheet-appendix 10-4 is a document used for tracking and reporting cases of mumps, including details necessary for public health monitoring and intervention.
Health care providers, laboratories, and public health officials are required to file the mumps surveillance worksheet-appendix 10-4 when they encounter suspected or confirmed cases of mumps.
To fill out the mumps surveillance worksheet-appendix 10-4, you should provide patient demographics, clinical information, laboratory results, and vaccination history as required in the specified sections of the form.
The purpose of the mumps surveillance worksheet-appendix 10-4 is to gather data for monitoring the incidence of mumps, guiding public health responses, and preventing outbreaks.
Information that must be reported includes patient identification details, symptoms, laboratory findings, vaccination status, and any relevant epidemiological links to other cases.
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