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If you have received this facsimile in error please immediately notify us at the telephone number listed above. CDPH 9064 11/14 CGSS 2. 0 - 11/17/2014 Page 1/5 PATIENT INTERVIEW FORM Process Information Patient Name Interviewer Name Contact Attempt Outcome check one only for each attempt Answer/Interviewed 1 date No Answer/No Message Answer/Hang up Answer/Reschedule DIS call back Answer/Refusal Number out of service Letter Sent 2 date 3 date 4 da...
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How to fill out gonorrhea case investigation record
How to fill out gonorrhea case investigation record
01
Gather patient information including name, age, and contact details.
02
Record the date of diagnosis and any symptoms the patient is experiencing.
03
Note the patient's sexual history, including number of partners and type of sexual activities.
04
Include laboratory test results confirming the diagnosis of gonorrhea.
05
Document any treatment given and the patient's response to treatment.
06
Record any follow-up appointments or referrals made.
07
Complete any additional fields relevant to local health department requirements.
Who needs gonorrhea case investigation record?
01
Healthcare providers diagnosing gonorrhea to ensure proper reporting and follow-up.
02
Public health officials for tracking and managing gonorrhea outbreaks.
03
Researchers studying gonorrhea epidemiology and treatment outcomes.
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What is gonorrhea case investigation record?
A gonorrhea case investigation record is a document used by health authorities to gather and track information related to confirmed cases of gonorrhea, an infectious sexually transmitted disease.
Who is required to file gonorrhea case investigation record?
Healthcare providers and laboratories that diagnose gonorrhea are required to file gonorrhea case investigation records to ensure proper tracking and management of the disease.
How to fill out gonorrhea case investigation record?
To fill out the gonorrhea case investigation record, you must provide patient demographics, clinical information, laboratory results, treatment given, and any follow-up actions taken.
What is the purpose of gonorrhea case investigation record?
The purpose of the gonorrhea case investigation record is to facilitate the monitoring of gonorrhea cases, inform public health responses, and track trends and outbreaks in the population.
What information must be reported on gonorrhea case investigation record?
The information that must be reported includes patient identity, demographics, clinical presentation, test results, treatment details, and any relevant epidemiological links.
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