Get Viral Hepatitis Case Report Form

This guide provides a clear and supportive overview of how to accurately complete the Viral Hepatitis Case Report Form online. By following these instructions, users can ensure that they provide all necessary information for reporting cases of viral hepatitis.

Follow the steps to complete the Viral Hepatitis Case Report Form effectively.

1. Press the ‘Get Form’ button to access the form and begin filling it out in your browser.
2. Start by entering the prefix, last name, preferred name (if applicable), first name, middle name, and maiden name. Provide this personal information accurately.
3. Fill in the address, including street, city, state, zip code, and phone number. Ensure that all given details are correct to facilitate communication.
4. Complete the optional section for Social Security Number (SSN) if you wish. This field may not be necessary for all users.
5. Choose the appropriate responses for whether this record has been submitted to the CDC through the NETSS system and provide any required identification numbers if applicable.
6. In the demographic information section, check all applicable boxes for race, sex, place of birth, and ethnicity. Make sure to provide accurate data to aid public health tracking.
7. Input the age and date of birth fields clearly. These are critical to understanding the demographics of the case.
8. In the clinical and diagnostic data section, check all reasons for testing that apply and document the relevant clinical data including diagnosis dates.
9. Mark all relevant diagnostic tests that have been completed and include the results, ensuring you provide accurate levels for liver enzymes and any other necessary details.
10. Complete the sections detailing patient history, vaccination history, and exposure risk factors, answering all questions to the best of your ability.
11. Review all filled information for accuracy, ensure every section is complete, and then finalize your entry.
12. Save changes to the form. After saving, you may choose to download, print, or share the completed form as needed.

Complete the Viral Hepatitis Case Report Form online today to contribute to important public health data.