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- Click ‘Get Form’ to open the KANSAS REPORTABLE DISEASE FORM in the editor.
- Begin by entering today's date at the top of the form. Fill in the patient's name, including last, first, and middle names.
- Provide contact information by entering home/cell phone and work phone numbers. Then, complete the residential address section with city and zip code.
- Indicate the patient's ethnicity and race by checking all applicable boxes. Specify if they are Hispanic or Latino, and select their race from the options provided.
- Fill in the patient's sex, date of birth, and age if DOB is unknown. Next, specify the disease name and whether the patient/guardian has been notified.
- List symptoms experienced by the patient along with their onset date. Indicate if there is an outbreak associated or if institutional residence applies.
- Complete laboratory information including specimen collection date, test performed, results, and laboratory name. Attach any relevant results as needed.
- Finally, provide treatment information including date of treatment, status, type/dosage of treatment, and any additional comments before submitting your form.
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What are the 11 notifiable diseases?
Details of Notifiable Diseases Source Of Infection And Prevention Whooping Cough (Pertusis) Plague Polio Rabies Small Pox Scarlet Fever Tetanus Tuberculosis Typhoid Fever Viral Encephalitis Mal Nutrition Vitamin A Deficiency5 more rows
What does it mean if a disease is reportable?
A disease that, when diagnosed, requires health providers (usually by law) to report to state or local public health officials.
Which diseases are reportable to the CDC?
Diseases reportable to the CDC include: Anthrax. Arboviral diseases (diseases caused by viruses spread by mosquitoes, sandflies, ticks, etc.) such as West Nile virus, eastern and western equine encephalitis. Babesiosis. Botulism. Brucellosis. Campylobacteriosis. Cancer. Candida auris, clinical.
What is the CT reportable disease form?
The PD-23 is the general disease reporting form and should be used if other specialized forms are not available. PD-23 forms may either be faxed to 860-920-3131 or submitted by hospital IPs directly into CTEDSS (where applicable).
What is a reportable disease?
A disease that, when diagnosed, requires health providers (usually by law) to report to state or local public health officials. Notifiable diseases are of public interest by reason of their contagiousness, severity, or frequency.
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