Get Hawaii State Doh Influenza Form

Filling out the Hawaii State Doh Influenza Form online is essential for efficient influenza surveillance and reporting. This guide will walk you through each section, ensuring that you complete the form accurately and efficiently.

Follow the steps to fill out the Hawaii State Doh Influenza Form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the date received by the state laboratory, entering the appropriate date if applicable.
3. Fill in the state department of health accession number if you have one; otherwise, leave it blank.
4. Under specimens collected for influenza surveillance only, mark the clinical diagnosis as 'Influenza like illness'.
5. Complete the specimen priority identification section by entering the name and address of the physician, school, or facility.
6. For the ILINET (sentinel) provider ID#, provide the necessary identification number and indicate if the patient has been hospitalized.
7. If the patient was hospitalized, enter the hospital name. Answer questions regarding unusual presentations and recent travel.
8. In the patient identification section, fill out the patient ID, name, sex, date of birth, age, and whether the patient is a healthcare worker.
9. Indicate if the patient has any underlying medical conditions and provide contact information including address, city, state, and ZIP code.
10. Continue by giving details about the patient’s occupation and work or school location.
11. Fill out the laboratory specimen and rapid testing information, noting the specified specimen type and details of clinical signs and symptoms.
12. Record the date of onset of symptoms and any rapid testing information.
13. Indicate vaccination and viral therapy history, providing all necessary details regarding flu vaccines and antiviral medications.
14. Finally, review all information on the form for accuracy, then save changes, download, print, or share the filled-out form as necessary.

Complete the Hawaii State Doh Influenza Form online today to support influenza surveillance efforts.