Get Measles/rubella/rash-fever Illness Investigation Form

Completing the Measles/Rubella/Rash-Fever Illness Investigation Form online is an essential process for reporting suspected cases of these illnesses. This guide will provide clear and supportive instructions to assist users in filling out the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the patient's name in the designated field. Start with the last name followed by the first name.
3. Provide your contact information in the 'Reported By' section, including your agency name, address, and phone number.
4. Select the suspected diagnosis from the options provided: Measles, Rubella, or Unspecified Rash Illness.
5. Fill out the demographics section, including the patient's date of birth, age, sex, race, and Hispanic ethnicity.
6. In the clinical data section, input information regarding the onset date of the rash and fever, along with their duration and maximum temperature.
7. Completing the complications section, check any complications experienced by the patient and indicate whether the rash is generalized.
8. Provide laboratory data if applicable, indicating whether laboratory testing was done and summarizing the results for each test performed.
9. Outline the vaccination history, confirming whether the patient received the measles or rubella vaccine, and provide the dates of vaccination.
10. Complete the infection timeline by entering dates related to the onset of symptoms and probable exposure.
11. Fill in the source of infection, indicating any known exposure to infected individuals or relevant locations.
12. List household contacts and potential spread contacts, detailing their relationship to the case and vaccination history where applicable.
13. Finally, provide your name and contact details in the investigator's section and indicate the dates for when the investigation was initiated and completed.
14. Once all required information is filled out, save your changes. You can then download, print, or share the completed form as needed.

Complete the Measles/Rubella/Rash-Fever Illness Investigation Form online to ensure timely and accurate reporting.