Get Md Dhmh 1281 2012-2025

The MD DHMH 1281 form is essential for reporting laboratory evidence of certain communicable diseases to the Maryland State Department of Health and Mental Hygiene. This guide provides clear instructions for successfully completing the form online, ensuring accurate and efficient reporting.

Follow the steps to fill out the MD DHMH 1281 online effectively.

1. Press the ‘Get Form’ button to access the MD DHMH 1281 form and open it in the designated editor.
2. Begin by entering the patient’s last name, first name, and middle initial in the respective fields.
3. If applicable, indicate the hospital number associated with the patient.
4. For female patients, indicate whether they are pregnant by selecting 'Yes' or 'No' in the designated section.
5. Input the patient’s date of birth, age, street address (including apartment number, if applicable), and contact information.
6. Fill in the ordering provider’s name, facility name, and address, including any suite or room numbers.
7. Specify the date the specimen was collected and its type (sputum, blood, stool, etc.) by selecting the appropriate checkbox.
8. Provide the date the specimen was received, the date the results were recorded, and the lab accession number.
9. Document the site of specimen collection and the name of the test performed along with the test number or code.
10. Include the results with the reference range and interpretation, specifically noting any organism results, including species and subtyping if known.
11. For hepatitis C results, input the Signal to Cut-Off Ratio, Critical Value for SCO, and any relevant hepatitis A or B results.
12. Finally, add the laboratory name, CLIA number, address, director, and contact phone number.
13. Review all entered information for accuracy, save changes, and utilize options to download, print, or share the completed form.

Complete your MD DHMH 1281 form online today to ensure timely and accurate reporting.