Follow the steps to successfully complete the case report form.

1. Select the ‘Get Form’ button to obtain the form and open it in your document viewer.
2. Enter the reporting details in the first section, which includes checking relevant boxes to denote the reporter's category, such as 'Laboratory', 'Hospital', or 'Public health agency'.
3. Provide the CDC case status by selecting either 'Confirmed' or 'Probable'. Fill in the first report date to the Local Health Jurisdiction (LHJ) and other specified dates accurately.
4. In the case information section, specify whether the case is 'Confirmed', 'Probable', or 'Suspect' and provide the disease or condition being reported along with relevant hospital details including admission and discharge dates.
5. Fill out the case demographic information with the individual’s last name, first name, middle initial, birth date, age, and current sex. Provide the address, city/town, zip code, and any sensitive occupation information as applicable.
6. In the laboratory information section, include details about the ordering facility, ordered test, health care provider, name of the laboratory, collection date, reported result, and contact phone number.
7. Complete the reporting information section by entering the reporter's name and phone number. Lastly, add any notes or comments in the designated notes section.
8. Once all sections are filled out, review the form for accuracy. You can then save changes, download the completed form, print it, or share it as necessary.

Complete your documents online today for efficient and compliant communication with health authorities.