Wisconsin disease form 2026

1. Click ‘Get Form’ to open the Wisconsin Disease Form in the editor.
2. Begin by filling out the 'Demographic Data' section. Enter the patient's name, date of birth, race, age, sex/gender, primary language, and contact information including home and cell phone numbers.
3. If applicable, provide details about the patient's employer or school. If the patient is a minor, include parent or guardian information.
4. In the 'Disease or Condition Data' section, indicate if the patient is pregnant and provide due dates if necessary. Fill in details regarding illness onset and hospitalization status.
5. Complete the 'Lab Data' section by entering specimen types and test results. Attach any available lab reports for comprehensive documentation.
6. Finally, fill out the 'Reporting Source' section with your contact information as a healthcare provider and submit the form via fax or mail to the appropriate public health agency.

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