Follow the steps to complete the assessment form correctly.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by filling out the demographics section, which requires your patient ID, facility name, date of interview, your name (first and last), sex, date of birth, age, address, phone number, and email address.
3. Answer the general rat exposure questions, indicating whether you wear gloves when handling rats and rat bedding/droppings. Provide details on the type of gloves used if applicable.
4. Respond to questions regarding exposure to rats from a facility with confirmed Seoul virus infections. If you have had contact, list the date of contact and details about the setting and nature of the contact.
5. Similar to step 4, provide information regarding any bites or scratches from rats, as well as contact with droppings or urine from infected facilities.
6. Indicate any contact you have had with other rats and provide the requested details about those interactions.
7. Complete the illness history section if applicable, noting any symptoms experienced since the effective date, and whether you sought medical care.
8. If you visited medical facilities, list their names, visit dates, attending doctors, and diagnoses. Also indicate if you were hospitalized and provide similar information for hospitalization.
9. Once all sections are filled out, review your entries for accuracy and completeness.
10. Save your changes, and you can then download, print, or share the completed form as needed.

Take the next step towards safeguarding your health by completing the UT DoH Seoul Virus Human Assessment Form online.