Get Wi Dhs F-01758 2016-2026

This guide provides a clear and user-friendly approach to completing the WI DHS F-01758 form online. You will find step-by-step instructions to help streamline the process and ensure that all necessary information is accurately recorded.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the demographic information. Fill in the patient's name, date of birth, and sex, selecting from the available options.
3. Indicate if the patient is pregnant at the time of diagnosis by selecting 'Yes' or 'No' and provide the due date if applicable.
4. Provide the patient's street address, city, zip code, and telephone numbers (home, work, and cell) to ensure accurate contact information.
5. Record the patient's occupation and race, selecting all that apply from the options provided.
6. In the symptom and signs history section, specify the source of the history by selecting from the options like 'Physician or chart/medical record', 'Patient or relative', or 'Both'.
7. Document the onset date of first symptoms and check all symptoms or signs present, as listed.
8. Answer the questions regarding prior diagnoses, progression of illness, duration of disease, and site of disease. Make sure to check the appropriate options.
9. Complete the clinical information section by filling in details about medical care sought, whether the patient was on a ventilator, prescribed medications, and outcomes.
10. Proceed to the diagnostic information section, indicating tests performed and their results, including microscopy, culture, serology, and radiology.
11. Fill out the risk factors section by checking all relevant medical conditions and answering questions about smoking habits and exposure to blastomycosis.
12. Complete the exposure history sections, providing information on outdoor activities and exposure to disturbed earth, including specific locations and dates.
13. Once all fields are completed, review the form for accuracy and completeness.
14. After ensuring all information is correctly filled out, you can save changes, download, print, or share the form as needed.

Start filling out the WI DHS F-01758 online today to ensure a thorough and complete submission.