Get Case Report Form Toxic Shellfish Poisoning - Public Health ... - Surv Esr Cri

The CASE REPORT FORM for Toxic Shellfish Poisoning is an important document for reporting incidents related to shellfish poisoning. This guide aims to provide clear and comprehensive instructions for completing the form online effectively.

Follow the steps to properly complete the form

1. Click the 'Get Form' button to access the CASE REPORT FORM and open it in your preferred editor.
2. Begin by entering the EpiSurv number in the designated field. This unique identifier is essential for tracking the case.
3. Select the type of disease by checking the appropriate box next to the listed types of shellfish poisoning.
4. Fill in the reporting authority details, including the name of the public health officer responsible for the case and the notifier identification. Specify the reporting source from the given options.
5. Provide detailed contact information for the reporting source, including their organization, phone numbers, and address.
6. Enter the case identification details, including the name, NHI number, email, and current address of the affected individual.
7. Complete the case demography section by indicating the location, date of birth, sex, age, and occupation of the case.
8. Specify the ethnic group the case belongs to by ticking all relevant options.
9. In the basis of diagnosis section, document the date interviewed, weight, seafood exposure details including the date and time seafood was eaten, and seafood species consumed.
10. Report any laboratory tests and results, including testing for toxins or microbiological pathogens relating to seafood consumption.
11. Indicate the clinical criteria and symptoms experienced by the case, detailing the timing and duration of these symptoms.
12. Complete the clinical course and outcome section by providing details on hospitalization and outcome status, including whether the case was part of an outbreak.
13. Once all sections are filled out, you can save your changes, download a copy, print the completed form, or share it as necessary.

Ensure you submit the completed form promptly to support public health initiatives.