Get Free Fillable Cdc Covid-19 Pui Form Pdf Form - Fill

This guide provides clear and supportive instructions on how to complete the Free Fillable CDC Covid-19 PUI Form online. Whether you are familiar with such documents or not, this comprehensive guide will assist you in accurately filling out the form.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the Free Fillable CDC Covid-19 PUI Form and open it in the suitable online editor.
2. Begin by filling in the patient identifier information. Enter the patient's first name, last name, and date of birth in the specified format MM/DD/YYYY.
3. Provide the reporting jurisdiction and health department details. Include any required local-use IDs that your health department may need for tracking.
4. Complete the interviewer information section, entering the name, organization, contact number, and email of the person conducting the interview.
5. Fill out the basic information regarding the patient's current status. Select the correct option such as 'PUI, testing pending' or 'Laboratory-confirmed case,' and note the relevant dates.
6. Indicate the patient's demographics including ethnicity, sex, and race. Be sure to provide accurate information based on the patient's responses.
7. Proceed to fill out the clinical details. This includes questions about symptoms, hospitalization, and any significant medical history related to COVID-19.
8. Detail the respiratory diagnostic testing results, indicating if tests were positive, negative, or pending for each relevant pathogen.
9. If applicable, record specimen information for COVID-19 testing, including specimen type, IDs, and collection dates.
10. Once all sections are completed, save your changes. You can then download, print, or share the completed form as necessary.

Feel empowered to complete your documents online with the help of this guide.