Get Md Dhmh 1140 2015-2025

The MD DHMH 1140 form, also known as the Maryland Confidential Morbidity Report, is a crucial document used by healthcare providers to report morbidity data. This guide provides step-by-step instructions for completing the form online, ensuring that you have a clear understanding of each section and field.

Follow the steps to fill out the MD DHMH 1140 form accurately.

1. Click 'Get Form' button to access the MD DHMH 1140 form and open it in the editor.
2. Fill in the state data base number, ensuring it is for the appropriate use by physicians and other healthcare providers, as laboratories should not use this form.
3. Complete the demographic data section by entering the patient's name, address, contact information, county of residence, ethnicity, date of birth, and age.
4. Indicate the patient's sex at birth, current gender, race, and employment status, along with any relevant information regarding the patient's occupation or contact with vulnerable persons.
5. In the morbidity data section, provide details about the disease or condition, including the date of onset and whether the patient was hospitalized or pregnant.
6. Document any relevant laboratory results by specifying tests, results, and dates, as well as the name of the lab where tests were conducted.
7. Include any additional symptoms, pertinent clinical information, and specify if the condition was acquired in Maryland.
8. Conclude by providing information regarding treatment given and whether medication was provided to partners, including drug dosages and additional notes.
9. After filling out all sections, review the information for accuracy. You can then save changes, download, print, or share the completed form.

Start completing the MD DHMH 1140 form online for accurate morbidity reporting.