NJDOH LYME DISEASE CASE INVESTIGATION FORM NJDOH Form CDS-14 2026

1. Click ‘Get Form’ to open the NJDOH LYME DISEASE CASE INVESTIGATION FORM in the editor.
2. Begin by filling out the PATIENT INFORMATION section. Enter the patient's name, birth date, phone number, and address. Select the appropriate race and ethnicity options.
3. In the CLINICAL INFORMATION section, indicate whether the clinician has diagnosed Lyme disease by selecting 'Yes' or 'No'. If applicable, provide the symptom onset date.
4. Detail any SIGNS OR SYMPTOMS experienced by the patient that are not explained by another etiology. Check all relevant boxes for rash, musculoskeletal issues, neurologic symptoms, and cardiac conditions.
5. Complete the RISK FACTORS section by noting any exposure to tick-infested areas and recent tick bites. Provide dates where applicable.
6. Fill in the TREATMENT section with dosage and duration details. Include treatment dates or mark as NOT TREATED if applicable.
7. Add any ADDITIONAL COMMENTS before finalizing your form.
8. Once completed, save your document and return it via fax as instructed at the bottom of the form.

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