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CASE REPORT FORMPertussisPertussisEpiSurv No. Reporting Authority
Name of Public Health Officer responsible for case OfficerNameNotifier Identification
Reporting source*
ReportSrcGeneral PractitionerHospitalbased
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How to fill out case report form pertussis
How to fill out case report form pertussis
01
Gather all necessary information on the patient's demographics, medical history, and symptoms related to pertussis.
02
Ensure all fields on the case report form are filled out completely and accurately.
03
Document the date of symptom onset, vaccination history, and any recent travel history.
04
Include any laboratory test results and diagnostic findings related to pertussis in the appropriate sections of the form.
05
Submit the completed case report form to the appropriate public health authorities for further analysis and tracking of pertussis cases.
Who needs case report form pertussis?
01
Healthcare providers who have diagnosed a case of pertussis.
02
Public health officials tracking and monitoring the prevalence of pertussis in a given population.
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What is case report form pertussis?
Case report form pertussis is a document used to report cases of pertussis (whooping cough) to the relevant health authorities.
Who is required to file case report form pertussis?
Healthcare providers, hospitals, clinics, and laboratories are required to file case report form pertussis.
How to fill out case report form pertussis?
Case report form pertussis can be filled out online or in paper form, providing information about the patient's demographics, symptoms, test results, and treatment.
What is the purpose of case report form pertussis?
The purpose of case report form pertussis is to track and monitor cases of pertussis for public health surveillance and control.
What information must be reported on case report form pertussis?
Information such as patient demographics, symptoms, test results, treatment received, and contact information must be reported on case report form pertussis.
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