Get C.4 Severe Respiratory Illness Case Definition And Report Form

The C.4 Severe Respiratory Illness Case Definition And Report Form is a crucial tool for documenting cases of severe respiratory illness. This guide provides a comprehensive overview of how to correctly fill out the form online, ensuring you provide all necessary information accurately.

Follow the steps to successfully complete the online form.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the patient contact information. This includes the last name, first name, and usual residential address. Make sure to include city, province or territory, postal code, and contact phone numbers.
3. If a proxy is responding for the patient, indicate 'Yes' and provide the proxy’s last name, first name, their relationship to the case, and contact number.
4. In the hospital information section, enter the name of the hospital treating the patient.
5. Proceed to Section 1: Case Definition and check the criteria for Severe Respiratory Illness. Ensure you provide accurate details related to the patient's condition.
6. In Section 2: Administrative Information, complete the initial report date, name, affiliation of the person making the report, and their contact number.
7. Fill out Section 3: Patient Information, which requires provincial/territorial residence, location details, gender, date of birth, and any specific identifiers such as Aboriginal status.
8. In Section 4: Clinical Information, note the date of onset of symptoms, check all relevant symptoms, and indicate if the patient was hospitalized, including dates of admission and discharge.
9. For Section 5: Medical and Vaccine History, indicate any antiviral treatments the patient has taken, as well as their vaccination history for seasonal and pandemic influenza vaccines.
10. In Section 6: Underlying Conditions and Risk Factors, confirm if the patient is pregnant or has any diagnosed underlying conditions, providing relevant medical history.
11. Complete Section 7: Laboratory Testing by noting specimen collection details, test results, and relevant laboratory information.
12. In Section 8: Exposures, describe any potential exposures the patient may have had, including health care or animal contact.
13. Finally, use Section 9: Summary of Close Contacts to record the total number of contacts the patient had prior to showing symptoms.
14. Once all sections are completed, review the form for accuracy. Save your changes, and you may choose to download, print, or share the form as needed.

Complete your documents online today to ensure timely and accurate reporting.