Get Kansas Reportable Disease Form

Completing the Kansas Reportable Disease Form online is an essential process for reporting health conditions. This guide provides clear instructions to help you navigate each section of the form with ease.

Follow the steps to complete the Kansas Reportable Disease Form effectively.

1. Press the ‘Get Form’ button to access the Kansas Reportable Disease Form and open it in your preferred editor.
2. Begin by entering today’s date in the designated field. This ensures that your submission is accurately timestamped.
3. Fill in the patient's name, providing their last name followed by their first and middle name, if applicable.
4. Insert the day and evening phone numbers of the patient to facilitate communication.
5. Complete the residential address by entering the city and zip code where the patient resides.
6. Select the ethnicity and race of the patient by circling the relevant options provided in the form.
7. Indicate the sex of the patient by selecting 'M' for male or 'F' for female.
8. Input the date of birth of the patient. If the date of birth is unknown, provide the patient's age instead.
9. Specify the disease name and outline the symptoms observed, along with the onset date of the symptoms.
10. Detail the three most prominent symptoms experienced by the patient, and indicate whether the case is outbreak associated and if they were hospitalized.
11. Provide the physician's name and phone number, ensuring that they can be contacted for further information.
12. Record the laboratory information, specifically the specimen collection date, the date the report was received, test performed, and test results.
13. Include details about treatment, indicating the treatment date, status, type, and dosage.
14. Finally, add any additional comments as necessary, ensuring you have reviewed all entered information for accuracy.
15. Once the form is completed, save your changes, and you may download, print, or share it as needed.

Complete the Kansas Reportable Disease Form online today to ensure accurate reporting and timely communication.