Get Form 135: Reportable Disease And Conditions - Mississippi State ... - Msdh Ms

Filling out the Form 135 for reportable diseases and conditions is an important process for healthcare professionals in Mississippi. This guide will assist you in accurately completing the form online to ensure that all necessary information is properly submitted.

Follow the steps to accurately complete the Form 135 online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin with the section labeled 'Disease or Condition'. Enter the specific disease or condition for which the report is being filed.
3. Fill in the 'Date of Onset' of the disease or condition.
4. If the patient was hospitalized, enter the chart number and the 'Date Laboratory Specimen Obtained'.
5. Complete the patient’s personal information including 'Name', 'Address', 'Occupation', 'Phone', and 'City'.
6. Indicate the patient's 'County', 'Hispanic Origin', 'Date of Birth', 'Current Age', 'Sex', and 'Race'.
7. Specify if the patient is a food handler or a child/worker in daycare by selecting Yes or No.
8. Document the details of the person reporting the condition and the attending physician.
9. If applicable, complete the disease or condition-specific information, including details for hepatitis or mycobacterial diseases.
10. For gonorrhea, chlamydia, or syphilis, provide the treatment details such as 'Date treated', 'Medication', 'Dosage', 'Frequency', 'Duration', and 'Route'.
11. Review all entered information for accuracy. Once verified, save your changes, and you may choose to download, print, or share the completed form.

Complete the Form 135 online today to ensure prompt reporting of diseases and conditions.