Get Reporting Form For Pertussis - Washington State Department Of ... - Doh Wa

Filling out the Reporting Form For Pertussis is an essential process for reporting respiratory illnesses related to pertussis in Washington State. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently online.

Follow the steps to complete your reporting form online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the identification details such as the ID number and the date reported to the Department of Health. Ensure you check the LHJ classification as confirmed, probable, or suspect based on the case information.
3. Provide information regarding the outbreak by entering the LHJ Cluster number, if applicable, and the DOH Outbreak number.
4. Fill in the reporter's details, including name, phone number, and primary healthcare professional's name.
5. Indicate if it is okay to speak with the case by selecting yes, no, or don't know.
6. Complete the patient information section which includes date of interview, patient’s name, address, contact numbers, and occupation or grade.
7. Next, address the clinical information section detailing the onset date, cough characteristics, any additional signs and symptoms, and hospitalization details if relevant.
8. Document the vaccination status of the patient including the number of doses received and the types of vaccines administered.
9. Follow with the infection timeline that captures the onset date of symptoms and exposure periods. Use the heavy box to enter these dates for clarity.
10. Lastly, review the public health issues and actions sections to detail potential connections to sensitive occupations or exposures and document any recommended prophylaxis.
11. After filling out all sections, ensure you save changes, and choose to download, print, or share the form as necessary.

Complete your reporting form online to ensure the accurate communication of public health information.