Get Ebola Virus Disease Contact Btracingb Form - Dhhr Wv

Completing the Ebola Virus Disease Contact Tracing Form is a vital step in ensuring public health and safety. This guide provides clear and supportive instructions to help users fill out this important form online, ensuring that all necessary information is accurately submitted.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to access the Ebola Virus Disease Contact Tracing Form and open it in your preferred online editor.
2. Begin by entering the date of the interview. Provide the interviewer's name, health department affiliation, business address, city, state, zip code, county, and contact details.
3. Indicate the person providing information for the form by checking the appropriate box and filling in their relationship to the contact. Specify if the contact is a minor and note the primary language spoken.
4. In the Ebola Case Information section, state the patient's condition as confirmed, probable, or unknown. Enter the date of illness onset.
5. For Contact Information, fill out the last name, first name, address details, and phone numbers. If applicable, provide previous address information.
6. Complete the Contact Demographics section, including the date of birth, sex, occupation, and household pet information. If you are a healthcare worker who treated an Ebola patient, follow the instructions to skip to the relevant section.
7. Answer the Exposure History questions comprehensively, specifying the relationship to the patient and detailing any direct contact with bodily fluids. Record date of last contact.
8. In the Activities During Period of Exposure section, check all relevant activities that occurred with the patient while they were ill and provide necessary details.
9. If you are a healthcare worker, fill out the Healthcare Facility Information section, detailing your job title, facility name, address, and exposure history.
10. Complete the Follow-up Actions section by providing details of monitoring recommendations and contact information for any follow-up.
11. Lastly, track your symptoms in the Contact Symptom Follow-Up Diary, indicating any health changes from the date of last exposure over the monitoring period.
12. Once all sections are completed, save your changes. You can choose to download, print, or share the completed form as needed.

Ensure public safety by completing your Ebola Virus Disease Contact Tracing Form online today.