Get the free Whooping Cough Surveillance Form - epid gov

EPIC/DS/WC/2007 SURVEILLANCE OF WHOOPING COUGH CASE INVESTIGATION FORM EPIDEMIOLOGY UNIT, MINISTRY OF HEALTH The MOH should do the investigation personally. Necessary data should be obtained from

How to fill out whooping cough surveillance form

How to fill out whooping cough surveillance form:

1. Start by providing your personal information such as your name, contact information, and any relevant identification numbers, if required.
2. Next, provide information about the patient who has been diagnosed with whooping cough. Include their full name, age, gender, and any other relevant details such as their address or contact information.
3. Specify the date and time of the diagnosis, as well as the healthcare provider who made the diagnosis.
4. Fill in details about the symptoms experienced by the patient. Include information such as the onset date of symptoms, the severity of the cough, and the presence of typical whooping cough symptoms like a "whooping" sound during breathing.
5. Inquire about any recent contact with an individual diagnosed with whooping cough. Fill out details of any potential exposure to the disease and the duration of contact if applicable.
6. Fill in information about any laboratory tests conducted to confirm the diagnosis of whooping cough. Provide the date of the test, the type of test conducted, and the results, if available.
7. Provide information about any preventive measures taken, such as vaccination or isolation of the patient. Include details of any medication prescribed or treatments administered to manage the symptoms of whooping cough.
8. Finally, sign and date the form to certify its accuracy and completeness.

Who needs whooping cough surveillance form?

1. Healthcare providers: Doctors, nurses, and other healthcare professionals who diagnose, treat, or come into contact with patients suspected or confirmed to have whooping cough may need to fill out the surveillance form. This helps in monitoring and tracking the spread of the disease.
2. Public health departments: Government agencies responsible for public health may require healthcare providers to submit whooping cough surveillance forms for statistical and epidemiological purposes. This information aids in surveillance, outbreak detection, and implementing appropriate control measures.
3. Researchers and scientists: Individuals and organizations involved in conducting research studies or epidemiological investigations related to whooping cough may request healthcare providers to fill out the surveillance form. This helps gather accurate data to analyze trends, risk factors, and the effectiveness of preventive measures.

Note: The specific requirements for filling out the whooping cough surveillance form may vary depending on the jurisdiction and the purpose for which the form is being used. It is essential to refer to the instructions provided by the relevant authorities when completing the form.

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What is whooping cough surveillance form?

The whooping cough surveillance form is a document used to track and monitor cases of whooping cough in a certain population.

Who is required to file whooping cough surveillance form?

Healthcare providers, hospitals, and public health agencies are required to file the whooping cough surveillance form.

How to fill out whooping cough surveillance form?

The whooping cough surveillance form can be filled out electronically or in paper form, with information such as patient demographics, symptoms, and laboratory test results.

What is the purpose of whooping cough surveillance form?

The purpose of the whooping cough surveillance form is to monitor and control the spread of whooping cough, also known as pertussis, in a community.

What information must be reported on whooping cough surveillance form?

Information such as patient demographics, symptoms, laboratory test results, and vaccination history must be reported on the whooping cough surveillance form.