Get the free Disaster-related Mortality Surveillance Form

Este formulario debe completarse para todas las muertes conocidas relacionadas con un desastre. La información debe obtenerse de un examinador médico, forense, hospital, funeraria o una oficina de DMORT (Equipo de Mortuoria de Desastre). Se debe completar un formulario por cada fallecido y enviarse diariamente al Centro de Operaciones de Salud Pública del Departamento de Salud de KY.

How to fill out disaster-related mortality surveillance form

How to fill out disaster-related mortality surveillance form

1. Obtain the disaster-related mortality surveillance form from the appropriate authority or organization.
2. Fill in the date of the disaster at the top of the form.
3. Provide details of the deceased, including full name, age, gender, and identification number if available.
4. Record the date and time of death.
5. Specify the cause of death as it relates to the disaster, including any relevant medical information.
6. Note the location where the body was found.
7. Indicate whether the death was counted as direct or indirect mortality related to the disaster.
8. Include any additional remarks or observations relevant to the case.
9. Review the information for accuracy and completeness before submission.
10. Submit the completed form to the designated health or emergency management agency.

Who needs disaster-related mortality surveillance form?

1. Public health officials responsible for monitoring and responding to disaster-related health impacts.
2. Emergency management organizations to assess the scale and impact of the disaster.
3. Researchers studying the effects of disasters on populations.
4. Government agencies conducting assessments for aid and recovery efforts.
5. Organizations involved in humanitarian response planning and resource allocation.

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What is disaster-related mortality surveillance form?

The disaster-related mortality surveillance form is a tool used to systematically collect and report data on deaths that occur as a result of disasters, both natural and man-made.

Who is required to file disaster-related mortality surveillance form?

Healthcare providers, public health officials, and other designated authorities responsible for monitoring health impacts during and after a disaster are required to file the disaster-related mortality surveillance form.

How to fill out disaster-related mortality surveillance form?

To fill out the disaster-related mortality surveillance form, one must provide details about the deceased individual, including identifying information, circumstances of death, and any relevant medical history related to the disaster.

What is the purpose of disaster-related mortality surveillance form?

The purpose of the disaster-related mortality surveillance form is to aid in the assessment of the impact of disasters on populations, guide response efforts, and inform public health planning and resource allocation.

What information must be reported on disaster-related mortality surveillance form?

The information that must be reported includes the date and location of the death, demographic details of the deceased, cause of death, circumstances related to the disaster, and any underlying health conditions.