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Case Report Form - Utah Department of Health

Case Report Form - Utah Department of Health 2025

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The document is a Malaria Case Surveillance Report from the Centers for Disease Control and Prevention (CDC), detailing patient information, lab results, travel history, treatment, and reporting requirements related to malaria cases. It includes sections for patient demographics, symptom onset, laboratory findings, and potential complications, aimed at tracking and managing malaria cases effectively.

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Click ‘Get Form’ to open the Case Report Form in the editor.
Begin by entering the State Case Number and DASH Number at the top of the form. This information is crucial for tracking and reference.
Fill in the patient's name, case number, and county. Ensure accuracy as this data is essential for patient identification.
Record the date of symptom onset using the mm/dd/yyyy format. This helps in understanding the timeline of the case.
Complete the physician's details, including their name and telephone number, to facilitate communication regarding the case.
Indicate lab results by checking appropriate boxes for smear results and species identification. This section is vital for diagnosis.
Provide demographic information such as age, sex, race/ethnicity, and pregnancy status to ensure comprehensive patient profiling.
Answer questions about travel history and malaria chemoprophylaxis taken. This information is critical for epidemiological tracking.
Finally, fill out any additional clinical complications or therapy details before submitting your report.

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What are the top 3 infectious diseases?

The worlds deadliest infections, including Tuberculosis, Malaria and /AIDS, have been considered as the Big Three infectious diseases (BTIDs).

How are infectious diseases reported?

Case surveillance of nationally notifiable diseases starts at local, state, and territorial public health departments. CSTE recommends state health departments report cases to CDCs National Notifiable Diseases Surveillance System. This system provides information about and resources for disease surveillance.

What is a notifiable infectious disease?

Notifiable diseases are diseases that must be reported to government health authorities. Reporting helps prevent and manage outbreaks.

How do I report an infectious disease in Utah?

Reports can be submitted by: Email: reporting@utah.gov. Phone: 1-888-EPI-UTAH.

What should you do if you have infectious diseases?

Treatment Antibiotics. Antibiotics are medicines that clear up illnesses caused by bacteria. Antivirals. These medicines can treat certain viruses. Antifungals. Topical antifungal medications that you put on the body can treat skin or nail infections caused by fungi. Anti-parasitics.