Get Hepatitis C Surveillance Revision Of Case Report Form For 2003 - Washoecounty

Filling out the hepatitis c surveillance revision of case report form for 2003 from Washoe County is essential for accurate data collection and public health reporting. This guide provides clear and detailed instructions to ensure that users can complete the form effectively and efficiently.

Follow the steps to accurately complete the form online.

1. Click ‘Get Form’ button to receive the form and open it in the editing interface.
2. In section A, personal and reporting information, enter the patient’s details such as their first name, last name, address, and date of report from the laboratory. Ensure all fields are completed to avoid follow-up inquiries regarding missing information.
3. For section B, demographic information, provide the date of birth and race/ethnicity of the patient. This information is crucial for identifying high-risk groups.
4. In section C, reason for testing, ensure only one box is checked, indicating the reason for the individual's hepatitis C test. Avoid leaving this section blank.
5. Section D requires the completion of clinical data. Mark ‘yes’, ‘no’, or ‘unknown’ for conditions like cirrhosis, liver cancer, and pregnancy.
6. In section E, test results, the CD Program staff will fill in test results based on laboratory data received. Ensure other relevant test results are marked appropriately if available.
7. Section F is for past history. Check all risk behaviors that apply and provide as much information as possible. If the client did not disclose any risk factors, leave the boxes blank.
8. For section G, present history, mark the relevant boxes for current behaviors such as injection drug use and whether routine medical follow-up is ongoing.
9. Section H requires checking the appropriate diagnosis box for hepatitis C and recording the date or year of diagnosis.
10. Finally, review all entered information for accuracy, save the changes, and then you can download, print, or share the completed form as necessary.

Start completing your documents online now for efficient health reporting.