Ma 16293 2026

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4.4 out of 5

338 votes

The document is a reporting form from the Massachusetts Department of Public Health for long-term care and assisted living facilities to report clusters of influenza or respiratory illness. It outlines the necessary information to be collected, including facility demographics, vaccination status, cluster details, laboratory testing results, and control measures taken. Facilities are encouraged to report any concerns promptly, as even one positive flu test is considered a cluster due to the potential for rapid spread.

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Click ‘Get Form’ to open the ma 16293 in the editor.
Begin by filling out the 'Facility Name' and 'Address' sections. Ensure all details are accurate, including city, state, and ZIP code.
In the 'Facility Type' section, select the appropriate option such as 'Assisted Living' or specify another type if necessary.
Complete the 'Vaccine Information' fields by entering the number of clients and staff vaccinated against influenza.
For 'Cluster Information', document any ill clients and staff, noting symptoms and onset dates. Be thorough in reporting any hospitalizations.
In the 'Laboratory Information' section, indicate whether lab testing has been done and provide results for tested individuals.
Finally, confirm that control measures have been implemented and notify your licensing agency as required before submitting the form.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (270 Votes)
2014	4.4 Satisfied (338 Votes)

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