Get Confidential Infectious Disease Report Form State Of Alaska, Section ...

Filling out the Confidential Infectious Disease Report Form State of Alaska is an essential process for health care providers to report infectious diseases. This guide provides step-by-step instructions to ensure that users can complete the form accurately and efficiently online.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in your document editor.
2. Begin with the patient information section. Fill in the last name, first name, and middle initial of the individual. Then enter the date of birth in the format mm/dd/yyyy.
3. Indicate the patient's race and sex, selecting the appropriate options. If applicable, mark whether the patient is pregnant and provide the estimated delivery date (EDC).
4. Complete the ethnicity field by choosing from Hispanic, Non-Hispanic, or Unknown options.
5. Fill out the physical address, including the city, state, and the various phone numbers (home, cell, and work) as applicable.
6. In the disease information section, write the name of the disease and specify whether the diagnosis was laboratory confirmed.
7. If applicable, select the type of specimen collected and provide the specimen collection date.
8. Provide the name of the medical facility, the attending health care provider, and the laboratory name if known.
9. Complete the reporting section by entering your name and the date reported. Lastly, be sure to verify fax transmission if you are sending the report through fax.
10. After completing all sections of the form, save your changes. You can then download, print, or share the form as needed.

Complete your documents online to ensure accurate reporting and timely submission.