Get Malaria Case Surveillance Form

Completing the Malaria Case Surveillance Form online is an essential step in reporting smear-confirmed cases of malaria. This guide will provide you with clear instructions on how to efficiently fill out each section of the form, ensuring accurate and timely reporting.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the Malaria Case Surveillance Form and open it in your preferred online environment.
2. In the 'State Case No' field, enter the case number if you are part of a state that assigns their own case numbers. If not, leave this field blank.
3. Skip the 'CSID No' and 'Case No' fields as these are for CDC use only.
4. Fill in the 'County' field with the reporting county name to classify the case.
5. Provide the 'Patient name' if permitted by local confidentiality regulations, or consider using initials or date of birth if necessary.
6. Enter the 'Date of birth' to assist in identifying duplicate cases, especially if the patient's name or other identifiers are unavailable.
7. Indicate whether the patient is pregnant by selecting 'Yes' or 'No'. This information is crucial for understanding the severity of malaria in pregnant individuals.
8. Report all positive lab results, including smear-confirmed, PCR-positive, and RDT-positive cases, regardless of the availability of other surveillance details.
9. Specify if specimens are being sent to the CDC for coordination of laboratory results.
10. List all countries of travel or residence outside the United States in the 'Country' field, using regions if specific countries are unknown.
11. Indicate if the patient resided in the U.S. prior to the most recent travel by selecting 'Yes', 'No', or 'Unknown', and provide the necessary details accordingly.
12. Select the 'Principal reason for travel from/to U.S.' and check the appropriate category based on the nature of the travel.
13. Indicate whether malaria chemoprophylaxis was taken during travel and specify which drugs were used.
14. Check 'Yes' if there has been a history of malaria in the last 12 months and provide details if applicable.
15. For previous blood transfusions or organ transplants within the last 12 months, indicate 'Yes' or 'No', but refrain from marking 'Yes' if related to the current malaria attack.
16. Complete Part II (if available) by filling in treatment regimen and outcome information, including symptom resolution and any adverse events experienced post-treatment.
17. Verify all provided information for accuracy before submitting, and utilize the options to save changes, download, print, or share the form.

Take action now and complete the Malaria Case Surveillance Form online.