Home
Forms Library
Ehrlichiosis - Missouri Department of Health

Ehrlichiosis - Missouri Department of Health 2026

Ehrlichiosis - Missouri Department of Health Preview on Page 1

See details

4.1 out of 5

36 votes

The document is a case report form from the Missouri Department of Health and Senior Services for public health surveillance of tick-borne rickettsial infections, including Anaplasma and Ehrlichia species. It provides detailed instructions for local disease investigators on verifying diagnoses, recording patient information, symptoms, laboratory evidence, exposures, and treatment. The form aims to ensure accurate reporting and tracking of these infections to aid in public health efforts.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Ehrlichiosis - Missouri Department of Health with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Ehrlichiosis - Missouri Department of Health case report in the editor.
Begin by entering patient information, including their name, address, and contact details. Ensure accuracy as this data is crucial for public health surveillance.
Fill in demographic details such as date of birth, age, sex, and race. This information helps in understanding the epidemiology of the disease.
Document medical provider information and confirm whether the provider has communicated test results to the patient. This section is vital for tracking diagnosis communication.
Record symptoms and clinical presentation by checking relevant boxes for symptoms experienced by the patient. Include any additional symptoms in the provided space.
Complete laboratory evidence sections by entering serology test results and any relevant PCR findings. Accurate lab data is essential for diagnosis confirmation.
Finally, review all entries for completeness and accuracy before signing off on the report to affirm your investigation's integrity.

Start using our platform today to streamline your form completion process for free!

See more Ehrlichiosis - Missouri Department of Health versions

We've got more versions of the Ehrlichiosis - Missouri Department of Health form. Select the right Ehrlichiosis - Missouri Department of Health version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2020	4.2 Satisfied (41 Votes)
2020	4.8 Satisfied (237 Votes)
2020	4.8 Satisfied (110 Votes)
2019	4.8 Satisfied (116 Votes)
2019	4.8 Satisfied (67 Votes)
2019	4.8 Satisfied (100 Votes)
2019	4.8 Satisfied (88 Votes)
2019	4.9 Satisfied (58 Votes)
2019	4.1 Satisfied (36 Votes)
2018	4.8 Satisfied (182 Votes)
2018	4.8 Satisfied (250 Votes)
2018	4.8 Satisfied (121 Votes)
2017	4.8 Satisfied (117 Votes)
2017	4.8 Satisfied (101 Votes)
2017	4.8 Satisfied (73 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the mortality rate for ehrlichiosis?

Ehrlichiosis is a serious illness that can be fatal if not treated correctly, even in previously healthy people. Severe clinical presentations may include difficulty breathing, or bleeding disorders. The estimated case fatality rate (i.e. the proportion of persons who die as a result of their infection) is 1.8%.

What happens if you dont treat ehrlichiosis?

Without prompt treatment, ehrlichiosis and anaplasmosis can have serious effects on an otherwise healthy adult or child. People with weakened immune systems are at a higher risk of more-serious and life-threatening complications. Complications of an untreated infection may include: Kidney failure.

What is the most common tick-borne illness in Missouri?

DHSS has prepared a fact sheet for each of the most common tickborne diseases in Missouri: Rocky Mountain spotted fever Document. Ehrlichiosis Document. Tularemia Document. Heartland and Bourbon viruses Document. Lyme/Lyme-like disease Document.

Does ehrlichiosis ever go away?

What are possible complications of ehrlichiosis? Brain problems, like confusion, seizures, or coma. Excess bleeding (hemorrhage) Heart failure. Breathing (respiratory) failure. Kidney failure. Septic shock.

What is the survival rate of ehrlichiosis?

Ehrlichiosis can be fatal if left untreated, and has a 1.8% case fatality rate. Immunocompromised individuals may experience a more severe clinical illness1,2.

Is ehrlichiosis a reportable disease?

Ehrlichioses are nationally notifiable conditions and cases should be reported to your state or local health department. A case report form for confirmed and probable cases may be submitted to CDC. Specimens may be submitted to CDC for diagnosis by state health departments.

Ehrlichiosis - Missouri Department of Health 2026

Here's how it works

How to use or fill out Ehrlichiosis - Missouri Department of Health with our platform