Get Or Reported Case Intake Form: Vaping - Associated Lung Injury 2019-2025

Filling out the OR Reported Case Intake Form: Vaping - Associated Lung Injury is an important step in documenting cases related to vaping-associated lung injuries. This guide provides a clear, step-by-step approach to help you successfully complete the form online.

Follow the steps to fill out the OR Reported Case Intake Form effectively.

1. Press the ‘Get Form’ button to access the OR Reported Case Intake Form and open it in the online editor.
2. Provide the required provider or reporter information by filling in your name, organization, phone number, and the date you are reporting the case.
3. Enter patient information and demographics, including the patient’s name, age, date of birth, parent or guardian’s name if under 18, contact number, street address, city, county, state (OR), zip code, sex, race, and ethnicity.
4. In the patient exposure section, indicate whether the patient has ever vaped, if they vaped in the last 90 days, how often they report vaping, if they vaped a nicotine-containing product, and whether they vaped a THC-containing product.
5. Fill out the patient clinical information, including the patient’s medical record number, date of initial symptom onset, admission date, and whether the patient was hospitalized. If hospitalized, include the discharge date.
6. Indicate if the patient was in an ICU, if they required mechanical ventilation, and list any symptoms experienced by the patient, such as fever, chills, cough, and others.
7. Complete the radiography section by noting if any imaging was done, specifying whether it was a chest X-Ray or CT, and include findings related to pulmonary infiltrates.
8. In the laboratory testing section, indicate whether laboratory tests were conducted and summarize test results.
9. Provide any additional clinical information, underlying conditions, current diagnosis from the provider, and any comments relevant to the case.
10. In the case determination section, check the applicable boxes to identify if the case meets the reporting criteria, and determine the appropriate status for the case in Orpheus.

Start filling out the OR Reported Case Intake Form online to ensure proper documentation and reporting.