Get Rda 2094 Form

The Rda 2094 Form is essential for reporting communicable diseases and events to the local health department in Tennessee. This guide provides step-by-step instructions to help users fill out the form accurately and efficiently online.

Follow the steps to complete the Rda 2094 Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient’s name in the designated field. Ensure that the spelling is correct.
3. Select the patient's gender by choosing either 'Male' or 'Female'.
4. Indicate the patient’s ethnicity by selecting either 'Hispanic' or 'Not Hispanic'.
5. Select the appropriate race from the following options: American Indian / Alaskan, Asian, Black / African American, Hawaiian / Pacific Islander, White, or Other.
6. Fill in the street address of the patient, followed by the city, state, county, and zip code.
7. Enter the patient's phone number with the appropriate area code.
8. Provide the patient's date of birth in the format: MM/DD/YYYY.
9. Indicate if the patient is pregnant by checking 'Yes', 'No', or 'Unknown'.
10. Add the physician's name and the date of STD treatment if applicable.
11. Fill in the facility or hospital name along with its phone number.
12. Provide details about the test and the specimen collection date.
13. Specify the specimen source from the available options.
14. Enter the result of the test.
15. Provide information regarding whether the patient died, was hospitalized, and other clinical information as required.
16. Finally, add the person reporting, their title, and their phone number.
17. Once all fields are completed, save your changes, download the form, print it, or share it as necessary.

Complete the Rda 2094 Form online today to ensure timely reporting of essential health information.