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Employer Name Address City State Zip Code Approved Date

Employer Name Address City State Zip Code Approved Date 2025

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The document is a detailed case report form for pertussis (whooping cough) that collects comprehensive information about a patient's demographics, clinical features, vaccination history, exposure risks, public health interventions, and laboratory results. It includes sections for administrative details, communication with healthcare providers, and treatment received. The form aims to facilitate the investigation and management of pertussis cases by local health jurisdictions.

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Click ‘Get Form’ to open the Employer Name Address City State Zip Code Approved Date form in the editor.
Locate the 'Employer Name' field. Enter the full name of the employer as it appears on official documents.
Next, find the 'Address' section. Fill in the street address where the employer is located, ensuring accuracy for correspondence.
Proceed to the 'City' field and input the city name associated with the employer's address.
In the 'State' dropdown, select the appropriate state from which your employer operates.
Enter the 'Zip Code' corresponding to the employer's address to ensure proper mail delivery.
Finally, mark the 'Approved Date' by selecting or entering the date when this information was verified or approved.

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Versions	Form popularity	Fillable & printable
2022	4.6 Satisfied (49 Votes)
2012	4 Satisfied (50 Votes)

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What is the employer zip code?

The Employer Zip Code is the postal code for your company or facility. Tip: If you dont know the Zip Code, you can look it up on the Internet. Refer to the United States Postal Service website, .

How to properly write city, state, and zip code?

Use the following guidelines: Always put the address and the postage on the same side of your mailpiece. On a letter, the address should be parallel to the longest side. All capital letters. No punctuation. At least 10-point type. One space between city and state. Two spaces between state and ZIP Code.

What is a city state zip code?

ZIP Codes are numbered with the first digit representing a certain group of U.S. states, the second and third digits together representing a region in that group (or perhaps a large city) and the fourth and fifth digits representing a group of delivery addresses within that region.