Get Melioidosis Case Report Form

This guide provides clear, step-by-step instructions for completing the Melioidosis Case Report Form online. By following these directions, users can ensure accurate and complete submissions for reporting cases of melioidosis.

Follow the steps to complete the Melioidosis Case Report Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by filling in the case name, first name, surname, date of birth, and notification ID. Ensure that all personal information is correct and accurately reflects the individual being reported.
3. Input the public health unit and outbreak ID, as well as the person's initial response dates and the notifier's information, including name, organization, phone number, and email.
4. Provide detailed case information, including the unique identification number, age, sex, and ethnicity. Indicate the permanent and temporary addresses if applicable, ensuring all contact information is clearly stated.
5. In the clinical details section, document the date of onset of symptoms, type of illness, hospitalization status, and any complications experienced by the patient.
6. For the laboratory section, enter the laboratory name and first specimen collection date, as well as the type of specimen.
7. Identify all risk factors by checking applicable boxes. Provide details of any malignancy or other chronic conditions if listed.
8. Specify the exposure period by outlining the dates from the illness onset and including any pertinent travel history.
9. Complete the occupational and recreational details, marking whether the individual engages in gardening and other activities that could indicate potential exposure.
10. Indicate where the melioidosis was acquired and finalize the notification decision by marking the appropriate case status.
11. Review all entries for accuracy, and once completed, save the form as a digital file, or choose to download, print, or share it with relevant health authorities.

Complete your Melioidosis Case Report Form online today to ensure timely and accurate reporting.