Form malaria 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part I. Fill in the 'State Case No' if your state assigns case numbers. Leave 'CSID No' and 'Case No' blank for CDC use.
3. Enter the 'County' where the case is reported, followed by the patient's name, ensuring compliance with local confidentiality regulations.
4. Provide the 'Date of Birth' to help identify duplicates. Indicate if the patient is pregnant, as this can affect treatment severity.
5. Report all positive lab results and specify if specimens are being sent to CDC for coordination.
6. List all countries of travel or residence outside the U.S., or use regional identifiers if specific countries are unknown.
7. Complete questions regarding residency prior to travel, principal reason for travel, and whether malaria chemoprophylaxis was taken.
8. In Part II, provide information on treatment outcomes if available, including symptom resolution and any adverse events experienced post-treatment.

Start filling out your form malaria today using our platform for a seamless experience!