Get Acute Gastroenteritis/norovirus Case Report Worksheet

This guide provides comprehensive instructions for completing the Acute Gastroenteritis/Norovirus Case Report Worksheet online. Ensuring accuracy in reporting is vital for public health, and this document aims to assist users in navigating the necessary fields effectively.

Follow the steps to accurately complete the worksheet.

1. Click ‘Get Form’ button to acquire the worksheet and open it in the editor.
2. Begin with the reporting facility section. Enter the name of the reporting facility. This is critical for tracking and identifying the outbreak source.
3. In the contact name/phone number section, provide the name of the individual responsible for the report and their contact number to facilitate follow-up communication.
4. For the estimated number of exposed patients and staff during the outbreak, enter approximate figures to reflect the scale of exposure.
5. Complete the street address and unit sections, ensuring to provide a complete location for accurate identification.
6. Input the outbreak identification number, which is assigned by the health department, to help categorize and track the case.
7. Specify the location of stool specimen testing by marking 'H' for health care facility lab, 'C' for contracted lab, 'S' for state lab, or 'CD' for CDC lab.
8. Enter lab results where applicable, including the date of specimen collection using the format mm/dd/yy.
9. Indicate if specimens were collected for diagnostics by responding Y, N, or Unk.
10. Answer whether the individual died due to the outbreak by marking Y for yes, N for no, or Unk for unknown.
11. Document the first symptom-free date and provide details on symptoms such as abdominal cramps, fever, bloody stools, diarrhea, and vomiting by marking Y, N, or Unk.
12. For symptom onset date, fill in the date using mm/dd/yy format.
13. Record demographic details including sex, age, and whether the individual is a patient or staff member.
14. If applicable, assign a unique ID for internal tracking of each case.
15. For patients only, note the room/bed number to identify where they were located during the outbreak.
16. Complete the case location to ensure the outbreak is mapped accurately.
17. For any additional entries, continue filling in as necessary, adhering to the provided structure.
18. If required, redact the name column prior to faxing.
19. Once all information has been entered, review the worksheet for accuracy.
20. Lastly, save your changes, download a copy, or print and share the filled-out form as required.

Complete your Acute Gastroenteritis/Norovirus Case Report Worksheet online today to contribute to public health efforts.