Get Lyme Disease (ld) Case Report Form - Dhss Delaware

Filling out the Lyme Disease (LD) Case Report Form online is a crucial step in reporting and managing cases of Lyme disease. This guide will provide you with detailed and easy-to-follow instructions to ensure accurate completion of the form.

Follow the steps to effectively complete the Lyme Disease case report form.

1. Click the ‘Get Form’ button to access the Lyme Disease Case Report Form. This will allow you to open the form in an online editing interface.
2. Begin filling out the patient information section. Enter the first name, last name, street address, telephone number, county, zip code, and date of birth. Ensure all information is accurate to avoid delays.
3. Select the appropriate gender for the patient. Options include Male or Female. If you prefer to leave this field blank, that is acceptable.
4. In the race and ethnicity sections, select the appropriate options that apply to the patient. This includes choices such as American Indian or Alaskan Native, Black or African American, Hispanic, White, and others.
5. Complete the physician/provider information section by entering the physician's name and address, along with their phone number. This is important for follow-up and verification.
6. Fill out the laboratory results section. Indicate the results of the EIA/IFA tests and provide additional context such as specimen source and specific band results for IgM and IgG tests.
7. In the clinical section, indicate whether the patient was diagnosed with Lyme disease. If yes, provide the date of diagnosis and select any relevant signs and symptoms from the provided lists.
8. Provide supplemental information, including whether the patient was pregnant at the time of illness, if they were hospitalized, and details about any antibiotics used.
9. Review the entire form for accuracy and completeness, ensuring all necessary information is filled out. Any missing information may delay processing.
10. Once you have completed the form, you can save your changes, download it for your records, print a copy, or share it as needed. Make sure to keep a copy for future reference.

Take the next step in documenting Lyme disease cases by filling out the form online today.