Get Dhhs 2124

This guide provides detailed instructions on how to effectively fill out the Dhhs 2124 form online. It is designed to assist users in navigating each section of the form with clarity and confidence.

Follow the steps to complete your Dhhs 2124 form effortlessly.

1. Press the ‘Get Form’ button to access the Dhhs 2124 form and open it for editing.
2. Begin filling in the patient’s details, including their birthdate, Social Security Number (SSN), and last name. Ensure accuracy for proper identification.
3. Enter the patient's first, middle, and any suffix or maiden names. Also, include their alias if applicable.
4. Verify if the lab results for this event are available in the NC Electronic Disease Surveillance System. If not, provide the results manually.
5. Complete the demographic information, including age, race, and ethnic origin. Check all relevant boxes to ensure comprehensive data collection.
6. Indicate whether the patient is a part of an outbreak by selecting ‘Yes’ or ‘No’ and provide details of the outbreak setting if applicable.
7. Fill out the geographic location of the patient's most likely exposure, specifying whether it occurred in their county, outside the county but within North Carolina, out of state, or out of the country.
8. Answer the questions regarding the patient's hospitalization status, pregnancy, and whether they were symptomatic for the disease.
9. Input any relevant information regarding diagnosis, testing, and treatment if applicable. Be sure to provide medication details and treatment dates where relevant.
10. Once all fields are completed, review the information for accuracy. Save any changes, and decide whether to download, print, or share the completed form.

Complete your digital documentation online with confidence!