Get Epi-2 Form - Texas Department Of State Health Services - Dshs State Tx

Filling out the EPI-2 Form correctly is essential for reporting notifiable conditions in Texas. This guide provides a clear, step-by-step approach to assist users in completing the form online, ensuring accurate submissions for public health concerns.

Follow the steps to successfully complete the EPI-2 Form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by selecting the type of reportable condition you are documenting, either by checking 'Onset' or 'Absence'. Fill in the date for the selected type.
3. Provide the physician's information. If applicable, you can check the option to 'See Facility address below' for the physician's address, then enter the physician's name and phone number.
4. Indicate the diagnostic criteria that applies to the case. This includes entering information about diagnostic lab test type, results, and specimen source, if relevant.
5. Fill in the patient's personal information. Enter the last name, first name, middle initial, address, date of birth (in mm/dd/yyyy format), city, age, and sex.
6. Provide additional demographic information, including telephone number, county, ethnicity, and race by checking the appropriate options.
7. Include any notes, comments, or additional information that may be necessary for the report, such as other lab results, clinical information, pregnancy status, or travel history.
8. Complete the reporting facility's details by entering the name, address, and the name of the person reporting along with their title and phone number.
9. Fill in the date of the report (in mm/dd/yyyy format) and if known, the reporting person's email address.
10. Finally, review the form for any errors or missing information. After confirming all details are correct, save your changes, download, print, or share the completed form as required.

Start filling out your EPI-2 Form online today for accurate reporting.