Get Multistate Fungal Infection Case Report Form, - Florida Department ...

This guide provides clear and detailed steps on how to complete the Multistate Fungal Infection Case Report Form provided by the Florida Department of Health. It aims to assist users in accurately filling out the form online, ensuring that all necessary information is included.

Follow the steps to successfully complete the case report form.

1. Use the ‘Get Form’ button to download the form and open it in your preferred online editor.
2. Begin by entering the CDC unique ID, which you can obtain by contacting the CDC. This number is essential for tracking and processing the case.
3. Fill out the Investigation ID using the format FL + County + sequence number. For example, if the case is from Marion County and is the first case reported, write 'FLMarion1'.
4. Provide the investigator's last name, first name, and contact phone number to ensure communication regarding the case.
5. Specify the date the form is completed, followed by the date when the county health department was notified.
6. Fill in the patient’s details including last name, first name, and middle initial as necessary, along with the parent's or guardian's first name.
7. Indicate the gender of the patient by marking the appropriate box (male, female, or unknown).
8. Record the date of birth, race, and ethnicity of the patient. Ensure to select the correct options from the provided list.
9. Complete the address section, including city, state, and zip code. If the information is unknown, mark that option.
10. List all contact numbers, including home and emergency phone numbers, ensuring accuracy for follow-ups.
11. Document the date of initial symptom onset and provide answers to whether the case was investigated, interviewed, and any relevant outcomes.
12. As you reach the later sections, include any treatment details and outcomes as applicable after the patient has been under treatment for at least two weeks.
13. Make sure all entries are double-checked for accuracy. Once complete, you can save the changes, download, print, or share the form.

Encourage others to file their documents online by using the provided guidelines.