Get Case Report Form Leptospirosis - Public Health Surveillance - Surv Esr Cri

Filling out the CASE REPORT FORM for leptospirosis is crucial for public health surveillance. This guide provides a detailed, step-by-step approach to ensure accurate completion of the form, facilitating timely reporting and management.

Follow the steps to complete the form online effectively.

1. Press ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the EpiSurv No. and the name of the reporting authority, specifically the public health officer responsible for the case. Ensure all information is accurate.
3. For notifier identification, select the appropriate reporting source (general practitioner, hospital-based practitioner, laboratory, self-notification, outbreak investigation, or other). Provide the name of the reporting source, organisation, and date reported.
4. Input contact information, including phone numbers and usual general practitioner details. Ensure the GP’s practice address, including number, street, suburb, town/city, and post code, is complete.
5. In the case identification section, fill in the case's name, NHI number, current address, and contact numbers.
6. Provide demographic details such as the case's location, date of birth, sex, and age. Specify the occupation and its location.
7. Indicate the ethnic group the case belongs to by ticking all applicable options.
8. For basis of diagnosis, respond to clinical and laboratory criteria questions, stating whether the clinical description fits and if laboratory tests were conducted.
9. Document the clinical course and outcome, including hospitalization details and whether the disease was the primary cause of death, if applicable.
10. Provide outbreak details, if relevant, specifying the outbreak number.
11. In the risk factors section, answer questions regarding exposure to animals, risks of leptospirosis and whether the case was overseas during the incubation period.
12. Complete the management section, detailing whether antibiotics were given for the episode of leptospirosis.
13. Finally, review all the information entered. Save changes, download, print, or share the completed form as required.

Complete your documents online today for efficient public health reporting.