Get Oh General Health District Varicella Report Form - Lorain County 2010-2025

Filling out the OH General Health District Varicella Report Form is an essential step in reporting varicella cases to the health department. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete the form online effectively.

1. Press the 'Get Form' button to access the Varicella Report Form and open it for editing.
2. Begin by filling out the demographic information. Enter the child's name, date of birth, age, and gender. Select the appropriate race from the list provided.
3. Indicate the child's ethnicity by checking either the Hispanic or Non-Hispanic option.
4. Provide the child's address, including the city, state, and zip code.
5. Input the parent's name and contact phone number for further communication.
6. Move to the clinical information section, and indicate whether a rash is present by selecting Yes, No, or Unknown.
7. Record the date of rash onset.
8. Specify the location of the rash on the child's body.
9. Indicate whether the child has experienced fever by selecting Yes, No, or Unknown.
10. Confirm whether the child has received the varicella vaccine and provide dates of vaccination for Dose 1 and Dose 2, if applicable.
11. Document the first date the child was absent due to chickenpox.
12. Assess the severity of varicella by selecting the appropriate option based on the number of lesions.
13. Indicate the outcome of the case — whether the child was hospitalized, alive, dead, or if the status is unknown.
14. Complete the section regarding the diagnosis and report the name of the diagnosing individual or agency.
15. Finally, provide the date of report and the source of the report detailing the agency name and type.
16. Once all sections are completed, you can save the changes, download, print, or share the form as necessary.

Ensure to complete and submit the Varicella Report Form online for prompt health reporting.