Get Mo Cs313648 (formerly Mo 580-2602) 2020-2025

Filling out the MO CS313648 form is essential for reporting tickborne rickettsial diseases accurately. This guide will provide you with step-by-step instructions to complete the form online, ensuring that you provide all necessary information correctly.

Follow the steps to successfully complete the MO CS313648 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the appropriate online platform.
2. Enter the patient's name in the designated field. Ensure that the spelling is correct to avoid errors.
3. Fill in the 'Date submitted' section using the format mm/dd/yyyy.
4. Provide the patient's address, including city, state of residence (using postal abbreviation), and any relevant local patient ID if applicable.
5. Indicate the patient's age at the time of case investigation.
6. Choose the sex of the patient by selecting the appropriate option (male, female, unknown).
7. Specify the county of residence.
8. Check the race of the patient; multiple selections may be necessary.
9. Indicate if the patient is of Hispanic or Latino ethnicity and provide details if known.
10. Answer whether the patient traveled outside their county, state, or country in the two weeks before symptom onset and provide the destination and dates.
11. Report any tick bites that the patient observed during the same time frame.
12. Provide clinical evidence details for tickborne rickettsial disease, indicating 'yes' or 'no' for various symptoms such as fever, rash, and headache.
13. If there were any complications due to the illness, specify them in the provided section.
14. Document the admission and discharge dates if the patient was hospitalized.
15. Fill out the antibiotic prescribed details including the type and duration of treatment.
16. If applicable, report any blood transfusions or organ transplants the patient received in the year prior to symptom onset.
17. Complete the sections regarding serology and other diagnostic tests, indicating results as necessary.
18. Once you have filled in all parts of the form, you can save your changes, download a copy, print, or share the completed form.

Complete your documents online today for efficient and accurate reporting.