Reporting Form For Pertussis - Washington State Department of ... - doh wa 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Reported to DOH' section, including the date and LHJ classification (Confirmed, Probable, Suspect). Indicate how the case was classified (Lab, Clinical).
3. In the 'REPORT SOURCE' section, enter the LHJ notification date and investigation start date. Check all applicable reporter types such as Lab, Hospital, HCP, etc.
4. Complete the 'PATIENT INFORMATION' section with details like name, address, birth date, gender, and contact information. Ensure accuracy for effective communication.
5. Fill in 'CLINICAL INFORMATION', noting symptoms and their onset dates. Include vaccination status and any relevant clinical findings.
6. Document exposure history in the 'EXPOSURE' section. Provide details about travel or contact with others who have similar symptoms.
7. Finally, review all sections for completeness before submitting your form through our platform.

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