Get Cdc Legionella Case Report Form Fillable

Filling out the Cdc Legionella Case Report Form Fillable online is essential for reporting cases of legionellosis efficiently and accurately. This guide provides clear, step-by-step instructions to help users complete the form with confidence.

Follow the steps to fill out the form correctly.

1. Click 'Get Form' to obtain the form and open it in your preferred editor.
2. Begin by entering the patient's name in the specified format: Last, First, and Middle Initial. Ensure accuracy as this information is crucial.
3. Provide the hospital name and telephone number. This makes it easier for health departments to contact the facility if necessary.
4. Fill in the patient’s complete address, including street number, apartment number (if applicable), city, state, and zip code.
5. Complete the patient identifier information. Note that this section is not transmitted to the CDC, ensuring privacy.
6. In the 'Patient Information' section, fill in the state health department case number, reporting state, and county of residence.
7. Enter the patient's date of birth, age, and sex. Choose from the provided options to classify this information accurately.
8. Indicate the patient's race and ethnic origin from the respective checkboxes. This information is vital for demographic tracking.
9. In the 'Possible sources of exposure' section, answer questions about recent travel, dental work, and hospital visits, providing details where applicable.
10. Check the appropriate box regarding whether the case was hospital-related. Choose from the options provided to clarify the situation.
11. Complete the clinical illness section by checking the applicable diagnosis and entering the date of symptom onset.
12. Indicate whether the patient was hospitalized and provide the hospital name and address if applicable.
13. Record the outcome of the illness, selecting from the options of survived, died, or unknown.
14. Fill in the methods of diagnosis, checking all that apply and providing necessary details such as dates and sites for each method.
15. Enter the interviewer's identification details, including name, affiliation, telephone number, and date of the interview.
16. Once all sections are filled out, ensure to review the information for accuracy, then save your changes or download, print, or share the completed form as needed.

Complete your Cdc Legionella Case Report Form Fillable online today to ensure accurate reporting and help manage public health effectively.