Get Varicella Reporting Form Colorado

This guide provides clear and concise instructions on how to fill out the Varicella Reporting Form for Colorado online. Understanding each section and field will ensure accurate and efficient reporting of chickenpox cases.

Follow the steps to successfully complete the Varicella Reporting Form.

1. Click ‘Get Form’ button to access the Varicella Reporting Form and open it for completion.
2. Begin by entering the name of the person affected by chickenpox in the designated fields for last and first name.
3. Fill in the date of birth, providing the correct format to avoid any errors.
4. Provide the home phone number for the person affected to enable communication if necessary.
5. Select the sex by checking the appropriate box: male or female.
6. Indicate the race of the individual by checking all applicable boxes.
7. Select the relevant ethnicity by checking the appropriate box.
8. Enter the county, city, and zip code in the specified fields.
9. Input the report date to document when the form is being filled out.
10. Provide the name and title of the person completing the form along with their contact number.
11. Identify the reporting site by entering the name of the clinic, school, or childcare center, and specify the type of reporting site.
12. Document the rash onset date and the first date the child was absent due to chickenpox.
13. Indicate whether the individual received the Varicella vaccine by checking yes, no, or unknown, and input vaccination dates if applicable.
14. Assess the severity of Varicella by checking the appropriate box that reflects the number of lesions.
15. State whether hospitalization occurred and choose the applicable option.
16. Identify the person or entity that diagnosed the case of chickenpox.
17. Select the outcome of the case by indicating alive, dead, or unknown.
18. If the individual attends school or childcare, indicate if others had chickenpox in the past three weeks.
19. Determine if this case is part of an outbreak and respond accordingly.
20. If relevant, fill in details about lab testing, including the collection date and results.
21. Once all fields are completed, save changes, download, print, or share the form as needed.

Complete your Varicella Reporting Form online today to ensure timely reporting of cases.