Get Ny Wcdh Tb Patient Intake Sheet 2012-2025

Filling out the NY WCDH TB Patient Intake Sheet online is an important step in ensuring that individuals receive proper health care and support. This guide provides a comprehensive overview of each section of the form, helping users navigate the process with confidence.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the TB Patient Intake Sheet and open it in your preferred editor.
2. Start by entering your last name in the ‘Name’ field, followed by your first name in the appropriate space.
3. Input your date of birth in the designated ‘DOB’ field.
4. If applicable, fill in any aliases or ‘Also Known As’ names in the provided space.
5. Complete the address section, ensuring to include your apartment number, city, and zip code.
6. Provide your telephone number, including home, work, or cell phone details.
7. Indicate how long you have lived at your current address as well as the length of time you have resided in Westchester County.
8. Fill out your birthplace, specifying the city and country.
9. Enter the date you entered the USA if you are a foreign resident.
10. Select your race and ethnicity from the drop-down lists provided.
11. Indicate your sex in the specified field.
12. Choose your outcome status: Alive or Dead. If deceased, provide the date of death and cause.
13. Select your occupation from the list of options, or specify your job title if it is not listed.
14. Fill in the name of your employer and the last day you worked.
15. Provide the name and report date of the individual who is reporting this information.
16. Indicate the reporting source selected from the dropdown options.
17. If applicable, fill in the details for medical diagnoses, lab report information, and insurance details.
18. Complete the sections regarding past history of TB, medications being taken, symptoms, and emergency contact information.
19. Review your completed form to ensure all sections are filled out accurately.
20. After verifying accuracy, save your changes, and decide whether to download, print, or share the completed form.

Complete your NY WCDH TB Patient Intake Sheet online today.