Get Investigation Of Chickenpox Form

Filling out the Investigation Of Chickenpox Form online is an essential process for reporting and managing cases of chickenpox. This guide will provide clear, step-by-step instructions to assist you in completing the form efficiently and accurately.

Follow the steps to complete the form online effectively.

1. Press the ‘Get Form’ button to access the Investigation Of Chickenpox Form and open it in your preferred online editor.
2. Begin by entering the patient information or demographics. Fill in the last name, first name, street address, date of birth, city, phone number, zip code, county, and date reported.
3. Select the patient's race, gender, ethnicity, and age. Use checkboxes to indicate if the patient identifies as White, African American/Black, Pacific Islander/Native Hawaiian, American Indian/Native Alaskan, Asian, or Hispanic/Latino, among other categories.
4. Provide school information. Indicate if the patient is a student by marking 'Yes', 'No', or 'Unknown'. If applicable, enter the grade level and school name. Include the teacher's name for elementary school students and the school district.
5. Record the patient's vaccination history. Indicate if the patient has a history of vaccination by checking 'Yes', 'No', or 'Unknown'. If they have been vaccinated, enter the number of vaccinations and the date of the last vaccine.
6. State whether the patient has had chickenpox previously. Check 'Yes', 'No', or 'Unknown', and if applicable, specify the age at which they had chickenpox.
7. Document when the school nurse is notified by providing the name and phone number of the parent or guardian.
8. Complete the clinical information section by indicating the rash onset date and counting the number of lesions. Choose from options if the patient has been hospitalized.
9. Indicate who diagnosed the condition by checking the appropriate box (parent/guardian, MD/nurse, school, or self). Add any additional notes as necessary.
10. Finally, provide the name and phone number of the individual or facility reporting the case, and include the date of reporting.
11. Once all fields are completed, save your changes, and use the options provided to download, print, or share the form as needed.

Complete the Investigation Of Chickenpox Form online today to ensure accurate reporting.