Get Congenital Syphilis Form - Centers For Disease Control And - Wwwn Cdc

Filling out the Congenital Syphilis Form is vital for reporting and managing cases effectively. This guide provides clear instructions for users, ensuring they can complete the form accurately and efficiently online.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Enter the mother's name, chart number, and case ID number in the designated fields. Ensure all information is accurate.
3. Fill in the address details including the number, street, city, state, and zip code. Double-check for spelling errors.
4. Input the obstetrician or gynecologist's name and contact number, ensuring it is current and correct.
5. Provide the infant’s name and pediatrician’s information accurately.
6. Record the date of the report to the health department, following the format provided (month/day/year).
7. Complete the section on the mother’s demographics, including state and county codes, residence ZIP code, and date of birth.
8. Proceed to fill in information related to the mother’s last menstrual period, obstetric history, and treatments received during pregnancy.
9. For the infant, detail the delivery date, vital status, birth weight, and any relevant tests. Include any findings such as treatment or reactive tests indicated.
10. Fill out any additional sections needed regarding maternal and child symptoms, tests, and classifications related to congenital syphilis.
11. Once all required fields are completed, you can save your changes, download the form, or print it for sharing or submission.

Complete the Congenital Syphilis Form online to ensure accurate reporting and care management.