Get Outbreak Summary Form - Arizona Department Of Health Services

The Outbreak Summary Form is a crucial document for reporting outbreaks in Arizona. This guide provides step-by-step instructions to help users accurately complete the form online, ensuring all necessary information is captured for effective outbreak management.

Follow the steps to complete the Outbreak Summary Form online.

1. Press the ‘Get Form’ button to access the Outbreak Summary Form and open it for editing.
2. Begin by filling out the basic information section. Enter the Outbreak ID number, name of the outbreak, facility name, and the dates when the local health department and the Arizona Department of Health Services were first notified.
3. Provide details about the county of exposure and who identified the outbreak, along with the dates when the investigation started and when it concluded.
4. In the clinical and epidemiological information section, specify the outbreak case definitions for confirmed, probable, and suspect cases. Include the dates that correspond to when the first and last cases became ill and when the initial and last exposures occurred.
5. Document the case information. Indicate the number of confirmed cases, probable cases, primary ill cases, suspect cases, and susceptible individuals. Calculate the attack rate percentage and record demographic data such as sex and age group.
6. Fill out the signs and symptoms identified during the outbreak. Check all applicable symptoms that were observed.
7. Record the incubation period and duration of illness. Input the shortest, median, and longest incubation periods and durations, noting any that are unknown.
8. In the severity section, indicate the number of cases that were hospitalized, visited the emergency room, or visited healthcare providers. Document any fatalities.
9. Complete the exposure and transmission section by specifying the primary setting and mode of transmission, noting any identified contaminated sources. List all contributing factors relevant to the outbreak.
10. If applicable, provide laboratory information including whether specimen kits were sent out, test types performed, and any identified etiology.
11. Detail the actions taken to control the outbreak. List all control measures initiated, including dates and specifications for each action taken.
12. Document any additional investigation methods performed such as interviews and environmental assessments.
13. Complete the supplemental information section, including any line lists, written reports, or educational materials provided.
14. Lastly, add any additional remarks that are pertinent to the outbreak or investigation.
15. After thoroughly reviewing the form for accuracy, save your changes. You may then download, print or share the completed form as needed.

Complete your documentation online for efficient outbreak reporting and management.