Get Ky Epid 200 2016-2026

The KY EPID 200 form is essential for reporting various diseases to the local health department in Kentucky. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to fill out the KY EPID 200 online.

1. Click ‘Get Form’ button to obtain the form and open it in your online editor.
2. Begin filling out the demographic data section. Include the patient's last name, first name, and middle initial, followed by their complete address, date of birth, age, state, city, and ZIP code. Also, provide a phone number and a patient ID number, if available.
3. Next, specify the patient's ethnic origin by marking either 'Hispanic' or 'Non-Hispanic.' For race, select the appropriate categories such as 'White,' 'Black,' 'Asian/Pacific Islander,' 'American Indian,' or 'Other.'
4. Indicate the patient's gender by checking 'Female,' 'Male,' or 'Unknown.' Then, enter the county of residence.
5. In the disease information section, input the disease or organism being reported, along with the date of onset and diagnosis, and any relevant symptoms or comments.
6. Provide additional clinical information, including the highest temperature, days of diarrhea, whether the patient was hospitalized, and if so, the admission and discharge dates along with the hospital name.
7. Indicate if the patient died and include the date of death if applicable, as well as if the patient was pregnant and if the case is associated with a school or daycare.
8. Complete the attending physician information by listing their name, agency, address, and phone number.
9. Fill out the laboratory information, including the date, disease tested, name or type of test, laboratory name, specimen source, and results.
10. If applicable, provide additional information regarding sexually transmitted diseases, including stage, site, and any resistance to medications.
11. Confirm your entries and ensure the accuracy of all information provided before proceeding to save, download, print, or share the completed form as needed.

Start completing the KY EPID 200 online today for efficient disease reporting.