Get Reporting Form For Cryptococcal Disease - Washington State ... - Doh Wa

This guide provides detailed instructions for filling out the Reporting Form For Cryptococcal Disease in Washington State online. Follow the steps outlined in this document to ensure accurate and complete reporting of cases.

Follow the steps to complete the reporting form effectively.

1. Press the ‘Get Form’ button to access the Reporting Form For Cryptococcal Disease. This will allow you to open the form in your digital environment.
2. Begin by filling out the top section labeled 'County' and provide your local health jurisdiction (LHJ) use ID, the date reported to the Department of Health (DOH), and the LHJ classification (confirmed or probable). Specify how the report was classified by selecting from the options: lab, clinical, or other.
3. In the 'Report Source' section, enter the LHJ notification date, the investigation start date, and the source of the report (e.g., lab, hospital, health care provider). Check all applicable boxes: public health agency or other.
4. Fill in the DOH use ID and the date the report was received by the DOH. Then, provide the reporter's details, including name and phone number, along with the name of the primary health care provider (HCP).
5. Complete the patient information section. Enter the patient's name, address, birth date, age, gender, and ethnicity. If applicable, note if the individual is homeless.
6. Next, provide clinical information. Enter the onset date, diagnosis date, signs and symptoms, and illness duration. Check the relevant signs and symptoms experienced by the patient.
7. Document any clinical findings and hospitalization details including hospital name, admit and discharge dates, and any preexisting conditions that may have contributed to the illness.
8. In the infection timeline section, detail the exposure period starting with the onset date. Record any travel locations or changes in residence during the past 13 months.
9. Address public health issues and specify treatment prescribed for the illness, including the types of medications used. Also, note any public health actions taken.
10. Once all sections are complete, review the document for accuracy. Save changes, download a copy, print the form, or share as needed.

Complete your Reporting Form For Cryptococcal Disease online to ensure timely and accurate reporting.