Get T Oxic S Hock Syndrome (tss) I Nvestigation Form - Adph

Filling out the Toxic Shock Syndrome (TSS) Investigation Form is crucial for accurate reporting and management of this serious condition. This guide will provide you with detailed instructions to ensure that you complete the form accurately and efficiently, helping you facilitate the investigation process.

Follow the steps to effectively complete the form.

1. Press the ‘Get Form’ button to access the Toxic Shock Syndrome (TSS) Investigation Form and open it in the corresponding document editor.
2. Begin with the basic demographic data. Fill in the last name, first name, middle name, date of birth (DOB), age, and confirm the current status of the patient (deceased or alive). Indicate current sex and provide home and cell phone numbers.
3. Next, enter the detailed address of the patient, including street address, city, state, and zip code.
4. Complete the investigation summary section. Fill in the investigation start date, status (open or closed), and the investigator’s name.
5. In the 'Streptococcal TSS Other Patient Information' section, specify the type of insurance, weight, height, and any additional notes related to this information.
6. Proceed to the reporting source section. Enter the date of the report and the reporting source name.
7. In the clinical section, provide the physician’s name, contact details, and hospitalization information including admission and discharge dates.
8. Answer all questions in the clinical section regarding illness dates, comorbidities, and types of identified infections.
9. In the epidemiologic section, answer questions about the patient's daycare involvement, residential status, and outbreak status.
10. Complete the required case assessment questions based on the definitions provided for Staphylococcal and Streptococcal TSS. This includes various clinical criteria and lab results.
11. After filling out all sections, review the form for completeness. Save your changes, and download or print the form if needed for submission.

Take the first step in your reporting process by completing the Toxic Shock Syndrome Investigation Form online today.