(PDF) Invasive Haemophilus influenzae type b disease in 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name, address, and date of birth in the designated fields. Ensure accuracy for proper identification.
3. Select the current sex and race from the provided options. This information is crucial for demographic tracking.
4. Fill in the reporting hospital and physician's name to establish a point of contact for further inquiries.
5. Document Hib vaccination history by entering doses and dates given. If applicable, indicate if an isolate was sent to CDC-AIP for serotyping.
6. Provide epidemiologic information regarding contact with known cases, daycare attendance, and any recent travel history. Be specific where required.
7. List household and close contacts, including their relationship to the case and vaccination history. This section helps track potential spread.
8. Finally, complete the form by signing your name, providing your phone number, and dating the document before submission.

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