Get Quarterly Tracking Of Birth Defects Report - Form - California ... - Cdph Ca

This guide provides comprehensive instructions for completing the Quarterly Tracking of Birth Defects Report - Form as required by the California Department of Public Health. By following these steps, users can accurately report necessary data on neural tube defects and chromosomal abnormalities efficiently online.

Follow the steps to fill out the form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the hospital or clinic in the designated field. Ensure that the details are accurate and reflect the reporting institution.
3. Input the street address, city, state, and ZIP code of the reporting hospital or clinic in their respective fields.
4. In the section titled 'Person Submitting Report', fill out the name of the individual responsible for the report, including the job title, department, degree, and contact number (with area code and extension).
5. Enter the date of report submission in the corresponding field. Make sure to use the correct format.
6. Indicate the reporting period by selecting from the available quarterly options: Quarter 1 (January-March), Quarter 2 (April-June), Quarter 3 (July-September), or Quarter 4 (October-December).
7. If there are no birth defect cases to report for the quarter, mark the designated box. Otherwise, input the number of neural tube defect cases and chromosomal abnormality cases in their respective fields.
8. Once all fields are completed, review the information for accuracy. If no cases are reported, you may submit the form as is.
9. Complete any additional companion forms and include available cytogenetic laboratory reports as necessary if there are cases to report.
10. Save your changes, download a copy for your records, and prepare to submit the form. You can print or share it as required.

Complete your Quarterly Tracking of Birth Defects Report - Form online today to ensure compliance with reporting requirements.