Get Florida Department Of Health, Practitioner Disease Report Form Complete The Following Information

The Florida Department of Health requires healthcare practitioners to report certain diseases and conditions using the Practitioner Disease Report Form. Filling out this form online is a straightforward process that ensures timely reporting and compliance with health regulations.

Follow the steps to conveniently fill out the form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editing tool.
2. Begin with the 'Patient Information' section. Enter the patient's social security number (SSN) and medical record number (MRN). Fill in the patient's last name, date of onset of the disease, date of diagnosis, first name, middle initial, and indicate if the patient has died, is hospitalized, or if this information is unknown.
3. Continue to the 'Medical Information' section. Include the hospital's name, gender of the patient, and if the patient is pregnant. Specify the patient's ethnicity and provide the date the patient was admitted. Indicate whether treatment was provided and specify the type of treatment if applicable. Ensure to attach laboratory results if available.
4. Provide the patient's address, ZIP code, date of discharge, insurance information, death date if applicable, birth date, and race. Mark whether laboratory testing was conducted.
5. Complete the 'Provider Information' section with your county, city, state, physician name, home phone, address, and additional contact details including other phone numbers and fax.
6. Review the list of reportable diseases and conditions. Ensure you provide accurate information regarding the reportable disease being reported, and include any comments if necessary.
7. Once all relevant sections are filled out, you may save your changes, download a copy of the form, print it for your records, or share it directly with the appropriate health department.

Take action now and complete the Florida Department Of Health, Practitioner Disease Report Form online for prompt reporting.