Lyme Disease Case Worksheet 2026

1. Click ‘Get Form’ to open the Lyme Disease Case Worksheet in the editor.
2. Begin by filling out the Demographic Information section. Enter the patient's name, date of birth, sex, and contact details. Ensure all fields marked in red are completed as they are essential for case classification.
3. Proceed to the Signs and Symptoms History section. Indicate whether a physician diagnosed Lyme disease and provide dates for symptom onset and diagnosis. Check any confirmatory or non-confirmatory signs and symptoms that apply.
4. In the Clinical/Supplemental Information section, input details about the reporting agency, hospitalization status, physician information, and prescribed medications. Select the duration of antibiotics given.
5. Complete the Diagnostic Information section by checking relevant tests performed and their results. Include collection dates and lab information where applicable.
6. Fill out the Exposure History section by indicating if there was exposure to potential tick habitats before illness onset. Specify counties if applicable.
7. Review all entries for accuracy before submitting your completed worksheet via fax or through WEDSS as instructed.

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