Health state mn uspeoplefoodsafetyIllness Reporting for Foodservice Fact Sheet - Minnesota Dept 2025

1. Click ‘Get Form’ to open the health state mn uspeoplefoodsafetyIllness Reporting for Foodservice Fact Sheet in our editor.
2. Begin by entering the Reporting Agency Name and Telephone at the top of the form. This information is crucial for tracking and communication.
3. Fill in the Patient's First and Last Name, Date of Birth (DOB), and Residence Street Address. Ensure accuracy as this data is essential for identification.
4. Provide details about the Date of Illness, Location where the illness occurred, County, and City. This helps in understanding the context of the illness.
5. Complete the Physician’s information including Name, Address, and Phone Number. If hospitalization occurred, indicate 'Y' or 'N' and provide Hospital Name and Date Hospitalized.
6. Fill out demographic details such as Race, Sex, Ethnicity, and whether the patient died due to this illness. Include any Pre-existing Aggravating Medical Factors.
7. Lastly, indicate if Air Conditioning was available and in use during the incident. Review all entries for completeness before submission.

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