Get Hepatitis A Case Investigation Form - Nicd

Completing the hepatitis a case investigation form is essential for proper case management and public health response. This guide will provide you with clear instructions on how to fill out the form online, ensuring that you can complete it accurately and efficiently.

Follow the steps to accurately complete the hepatitis a case investigation form.

1. Press the ‘Get Form’ button to access the form and open it in your editing tool.
2. Begin by filling out the district cdc name, district name, and sub-district name in the designated fields.
3. Indicate the name of the respondent if they are different from the case. Choose from the options provided: case, parent, caregiver, guardian, or other. If applicable, specify in the provided space.
4. Enter the interviewer details, including the name, surname, contact details, designation, and the name of the healthcare facility.
5. For the case (patient) details, fill in the full name, date of birth, age, gender, race, street address, suburb, town/city, occupation, and employer's contact details.
6. In the clinical details section, input the date of onset of symptoms, date of presentation to healthcare facility, and select the symptoms experienced by the patient.
7. Note any complications or final outcomes for the patient as specified in the appropriate sections.
8. Provide details regarding risk factor history, including contact with suspected or confirmed cases, travel history, and previous visits to healthcare facilities.
9. Complete the public health response section, indicating if the case was notified on the GW17/5 form, along with notification and investigation dates.
10. Finally, document personal details of contacts, their ages, dates of exposure, and actions taken. If additional contacts are identified, use a separate sheet.
11. After filling out all the sections, review your entries for accuracy. Once completed, you can save your changes, download, print, or share the form as needed.

Complete the hepatitis a case investigation form online today to ensure a timely public health response.