Get the free H1N1 Case Report Form - PHPA

MESS ID # Influenza A(H1N1) (formerly swine flu) Case Report Form (FAX to: OR 410-669-4215) State EPI ID # (epidemiology ID) CDC EPI ID # State lab specimen ID #1 CDC lab specimen ID #1 State lab

How to fill out h1n1 case report form

How to fill out h1n1 case report form:

1. Start by ensuring that you have the correct version of the h1n1 case report form. Check for any updates or revisions that may have been made.
2. Carefully read through the instructions provided on the form. Familiarize yourself with the sections and the information that needs to be provided.
3. Begin by entering the necessary personal details of the patient, such as name, age, gender, and contact information. Make sure to double-check the accuracy of the information entered.
4. Proceed to fill out the medical history section, which usually includes questions about pre-existing medical conditions, allergies, and any medications the patient is currently taking.
5. Provide a detailed account of the symptoms experienced by the patient. This may include information regarding the onset of symptoms, their severity, and any specific treatments or medications used.
6. If the patient has been hospitalized, indicate the dates of admission and discharge, as well as any relevant information about the hospital or medical facility.
7. Document any laboratory or diagnostic tests that have been conducted, such as blood tests or imaging studies. Include the date of the test, the type of test performed, and the results.
8. Additionally, provide information about any known contacts with individuals who have tested positive for h1n1, as well as any travel history that may be relevant.
9. Finally, review the completed form to ensure that all sections have been filled out accurately and completely. Make any necessary corrections before submitting the form.

Who needs h1n1 case report form?

1. Healthcare professionals: Doctors, nurses, and other healthcare providers are responsible for filling out h1n1 case report forms. These forms are vital for tracking and monitoring cases of h1n1 influenza, as well as ensuring appropriate treatment and public health measures.
2. Public health agencies: Local, state, and national public health agencies require h1n1 case report forms to collect data on the prevalence and spread of h1n1 influenza. This information helps in monitoring outbreaks and developing strategies to control the spread of the virus.
3. Researchers and scientists: H1n1 case report forms are valuable sources of data for researchers and scientists studying the epidemiology and characteristics of the h1n1 virus. This information aids in improving diagnostic methods, treatment options, and preventive measures.

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What is h1n1 case report form?

The h1n1 case report form is a document used to report cases of the H1N1 influenza virus.

Who is required to file h1n1 case report form?

Healthcare providers and medical facilities are required to file the h1n1 case report form.

How to fill out h1n1 case report form?

The h1n1 case report form can be filled out by providing information about the patient's symptoms, test results, and demographic information.

What is the purpose of h1n1 case report form?

The purpose of the h1n1 case report form is to track and monitor cases of the H1N1 influenza virus for public health purposes.

What information must be reported on h1n1 case report form?

Information such as the patient's name, age, symptoms, test results, and date of diagnosis must be reported on the h1n1 case report form.