Get In Form 43823 2018-2025

This guide provides a step-by-step approach to completing the IN Form 43823 online. By following these instructions, users will gain clarity on each section of the form, ensuring accurate and efficient submission.

Follow the steps to complete the form online efficiently.

1. To obtain the form, click the ‘Get Form’ button to access the IN Form 43823. This action opens the document in an editable format.
2. Begin by filling out the personal information section. Include the full name, address, city, ZIP code, and county. For minors, provide the name of the parent or guardian.
3. Indicate the telephone number and date of birth. Choose the sex category and complete the race and ethnicity fields as applicable.
4. In the next section, input the name of the workplace or school, and indicate if the person is pregnant or not.
5. For clinical information, record the date of diagnosis, list any symptoms, and provide the onset date. Indicate if the individual was hospitalized and if they are immunocompromised.
6. Complete the laboratory section by documenting test results, the specimen collection date, specimen source, and details of the laboratory name and telephone number.
7. In the treatment section, specify the name of the antibiotic, dosage, frequency, and duration of treatment, along with the treatment date.
8. Provide details regarding the reporting physician and the person reporting the case. Fill in the facility or hospital name and contact information.
9. Record the date of first notification, the investigator’s name, and the date of the report. Complete any required local health department details.
10. After reviewing all entries for accuracy, you can save the changes, download, print, or share the form as necessary.

Complete your IN Form 43823 online efficiently today!