Dhmh 1281 fillable-2025

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4.8 out of 5

42 votes

The document is a confidential report template for laboratory evidence of communicable diseases, intended for reporting to the Maryland State Department of Health and Mental Hygiene. It includes sections for patient information, specimen details, test results, and laboratory information, specifically excluding HIV and CD4 reporting.

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Click ‘Get Form’ to open the dhmh 1281 fillable in the editor.
Begin by entering the patient's last name, first name, and middle initial in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in the hospital number and date of birth. If applicable, indicate if the patient is pregnant by selecting 'Yes' or 'No'.
Complete the address section with street, apartment number, city, state, and zip code. Include contact details such as phone and fax numbers for both the ordering provider and facility.
Specify the type of specimen collected by checking the appropriate box (e.g., Sputum, Blood). Record relevant dates including when the specimen was collected and received.
In the results section, provide detailed test information including site of specimen, name of test, result interpretation, and any critical values if applicable.

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Versions	Form popularity	Fillable & printable
2012	4.8 Satisfied (42 Votes)
2008	4.2 Satisfied (68 Votes)

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