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. Pertussis case investigation form PAPUA NEW GUINEA NATIONAL DISEASE SURVEILLANCE SYSTEM Pertussis Case Investigation Form Name of Health Facility: ___ Province: ___District ___ EPID NO:___ Person Reporting: ___Date of Report: ___ / ___ / ___ Date of investigation: ___ / ___ / ___A)Patient Details1. Surname: ___ First name: ___ 2. Sex: Male Female 3. Date of birth: ___/___/___ Age: ___ Years Months Weeks Days B)Clinical History of PatientSymptoms: 4.Date of first symptom onset: ___/___/___5

How to fill out pertussis case investigation form

How to fill out pertussis case investigation form

1. Obtain the pertussis case investigation form from your local health department or the appropriate health authority.
2. Fill out the patient's personal information, including name, age, gender, and contact details.
3. Record the date of onset of symptoms, including cough, fever, and any other relevant signs.
4. Note any relevant vaccination history, including the dates of pertussis vaccinations.
5. Complete sections related to the patient's exposure history, including any known contact with confirmed cases.
6. Document the clinical information, including laboratory test results if available, and any other medical history pertinent to the diagnosis.
7. Review all completed sections for accuracy and completeness.
8. Submit the form to the local health department, ensuring it is sent within the required time frame for reporting.

Who needs pertussis case investigation form?

1. Healthcare providers who suspect a case of pertussis in a patient.
2. Public health officials conducting surveillance of pertussis cases.
3. Laboratories identifying pertussis pathogens.
4. Schools or childcare facilities to implement control measures when a case is reported.

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What is pertussis case investigation form?

The pertussis case investigation form is a standardized document used by public health authorities to collect detailed information about individuals diagnosed with pertussis (whooping cough) to understand outbreaks and manage public health responses.

Who is required to file pertussis case investigation form?

Healthcare providers and public health officials are required to file the pertussis case investigation form for any confirmed or suspected cases of pertussis in order to ensure proper tracking and management of the disease.

How to fill out pertussis case investigation form?

To fill out the pertussis case investigation form, the reporter must gather patient data including demographics, clinical details, vaccination history, and exposure history, and then accurately complete all sections of the form as per the guidelines provided by health authorities.

What is the purpose of pertussis case investigation form?

The purpose of the pertussis case investigation form is to facilitate the collection of consistent and comprehensive data on pertussis cases, which aids in surveillance, outbreak investigation, contact tracing, and implementing control measures to protect public health.

What information must be reported on pertussis case investigation form?

The information that must be reported on the pertussis case investigation form typically includes patient identification details, clinical symptoms, laboratory test results, vaccination status, demographic information, and contacts of the patient.