Get Doh 389
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the Doh 389 online
The Doh 389 form is a crucial document used for reporting confidential cases within the New York State Department of Health. This guide provides a detailed, step-by-step approach to successfully completing the form online, ensuring that you provide all necessary information accurately and efficiently.
Follow the steps to effectively complete the Doh 389 form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin with the patient information section. Enter the patient's name, including last name, first name, and middle initial. If there is an alias, provide it in the designated field.
- Fill in the guardian's information, including the guardian’s name, first name, middle initial, and last name, if applicable.
- Input the patient's date of birth and physical address. Include the street address, city, zip code, and the patient's primary phone number.
- Indicate the patient's age and country of birth. You will also need to provide a secondary phone number if available.
- Record the patient's occupation by selecting one of the available options or indicating 'Other' if it does not fit.
- Choose the patient's sex and indicate if they are pregnant. If the patient is pregnant, provide the due date; otherwise, note the date of death if applicable.
- Check all applicable races and ethnicity classifications, such as White, Black, and Hispanic, to accurately reflect the patient’s background.
- Specify the disease, site of infection, date of first symptom, and whether the patient was hospitalized. Indicate the setting where the patient resides or attends.
- Provide the patient's mailing address, if different from their physical address, and confirm if the patient is alive.
- Detail the date of diagnosis, hospital name, admission and discharge dates, and medical record number.
- In the reporter information section, enter your information, including your name, telephone number, address, and the source of the report.
- Complete the reporting laboratory and relevant comments section, including any applicable laboratory data, treatment, or recent travel information.
- In the 'For Local Health Department Use' section, fill in required details regarding outbreak status and case status, and provide your signature.
- Review all information entered for accuracy, then save changes, download, print, or share the form as necessary.
Complete the Doh 389 form online today to ensure accurate and timely reporting.
A reportable disease is reported by submitting a notification form to the relevant health department, following the procedures outlined in the Doh 389 guidelines. This may involve electronic submission or mailing a paper form, depending on local regulations. To streamline this process, the uslegalforms platform offers templates and resources that simplify reporting. By ensuring accurate reporting, you contribute to community health efforts.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.