MTCDEpi initial case report form062012 docx LCP RELEASE OF INFORMATION - dphhs mt 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Reporter' section. Check all applicable boxes such as Laboratory, Hospital, or Public health agency to indicate who is reporting the case.
3. In the 'CDC Case Status' section, select either Confirmed or Probable based on the case details.
4. Enter important dates in the 'First report date to LHJ' and 'LHJ Investigation start date' fields. Ensure accuracy for proper tracking.
5. Complete the 'CASE INFORMATION' section by indicating if the case is Confirmed, Probable, or Suspect. Fill in disease/condition details and hospitalization status.
6. Proceed to 'CASE DEMOGRAPHIC INFORMATION'. Input personal details including name, birth date, sex, and address. Be thorough for accurate demographic tracking.
7. In 'LABORATORY INFORMATION', provide details about the ordering facility and tests ordered. This information is crucial for follow-up actions.
8. Finally, complete the 'REPORTING INFORMATION' and any additional notes required before submitting your form.

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