Get Notifiable Conditions Report Form (ccepi-1) - Cameron County - Co Cameron Tx

The Notifiable Conditions Report Form (CCEPI-1) is essential for reporting specific health conditions in Cameron County. This guide provides clear, step-by-step instructions on how to accurately complete and submit the form online, ensuring compliance with health regulations.

Follow the steps to effectively complete the Notifiable Conditions Report Form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your online editor.
2. In the 'Submitting (Reporting) Facility' section, enter your facility's name, the name and title of the person submitting the report, their contact telephone number with extension, and the date of submission.
3. For the 'Notifiable Condition Reporting' section, select whether the condition is acute or chronic by marking the appropriate box.
4. Enter the initial onset date of symptoms and choose the diagnosis type by marking one of the options provided, including Clinical, Culture/PCR, Serology, or Biopsy/Smear.
5. Fill in the date of diagnosis for the notifiable condition and enter the name and address of the diagnosing physician.
6. Provide the patient’s details, including last and first name, date of birth, physical address, sex, race, and ethnicity.
7. If the patient is a minor, list the names and contact information of their parent(s) or guardian(s).
8. Make sure to attach confirmatory lab results to the form before submission.
9. Finally, review the completed report for accuracy and ensure all required fields are filled. You can save your changes, download the completed form, print it out, or share it as needed.

Take the next step towards reporting by filling out the Notifiable Conditions Report Form online today.