Get The District Of Columbia Department Of Health Hahsta Notifiable ...

Filling out the The District Of Columbia Department Of Health Hahsta Notifiable Disease Report Form is an essential step in reporting notifiable diseases. This guide provides clear, step-by-step instructions to help you complete this form accurately and efficiently online.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin with the health provider information section. Fill in your reporting facility name, the date the form is completed, the person completing the form, their phone number, the city, county or ward, state or country, street address, and ZIP code.
3. Indicate the program type by checking one of the available options: CTR, SBSP, YSSP, or N/A.
4. Proceed to the patient identifiers and demographics section. Enter the patient’s last name, first name, social security number, medical record number, and date of birth. Specify the address type by selecting one: Residential, Correctional Facility, Foster Home, Homeless, Postal, Shelter, Temporary, or other.
5. Provide the current street address, city, sex assigned at birth, and gender identity. If applicable, indicate if the patient is pregnant and note the number of weeks.
6. Select the patient’s ethnicity and provide the patient’s phone number, county/ward, state/country, and ZIP code.
7. Indicate whether the patient has been notified that they may be contacted by DOH Disease Intervention Specialists by answering yes or no.
8. In the patient history section, record the date of the exam and the reason for the exam.
9. Document the gender of the patient’s sex partner(s), whether the patient used injection drugs, and if the patient was on PrEP.
10. Move to the diagnosis and treatment section. For each diagnosed condition such as chlamydia, gonorrhea, hepatitis B, hepatitis C, syphilis, and others, provide relevant details including positive specimen sites, treatment dates, and medications administered.
11. Make sure to include any additional comments or notes if necessary.
12. After completing all sections, save your changes, download, print, or share the form as needed.

Complete your notifiable disease report form online today.