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Protected B when completed Version 10.10 (Last updated March 08, 2024)Ebola Disease Case Report Form Section 1: Case Protected Information Local / Provincial / Territorial use only Do not forward
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How to fill out ebola disease case report

01
Gather all relevant information about the patient including symptoms, travel history and contact with other individuals who may have the disease.
02
Use the appropriate form provided by the health department or agency to document the case report.
03
Fill out the patient's personal information such as name, age, gender, and address.
04
Document the onset of symptoms and any relevant dates such as when the patient sought medical attention.
05
Describe the patient's symptoms in detail, including any laboratory test results that confirm the diagnosis.
06
Include information about the patient's travel history and any contact with individuals who may have been exposed to the disease.
07
Submit the completed case report to the appropriate health authorities for further investigation and monitoring.

Who needs ebola disease case report?

01
Healthcare professionals
02
Public health officials
03
Government agencies
04
Research institutions
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An Ebola disease case report is a formal document used by healthcare professionals to report confirmed cases of Ebola virus disease, including relevant clinical information, exposure history, and patient demographics.
Healthcare providers, laboratories, and public health officials are required to file Ebola disease case reports for each confirmed case under their jurisdiction.
To fill out an Ebola disease case report, providers should accurately complete all required fields, including patient information, symptoms, diagnostic tests performed, and exposure history, ensuring that the report is submitted to the designated health authority.
The purpose of an Ebola disease case report is to facilitate disease surveillance, track outbreaks, initiate public health responses, and ensure appropriate care and management of affected individuals.
The report must include patient demographics, clinical symptoms, laboratory test results, exposure history, and any travel history to Ebola-affected areas.
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