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State Form 51657 Q-Fever Case Investigation - Indiana
What Is State Form 51657?
This is a legal form that was released by the Indiana State Department of Health - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 51657?
A: Form 51657 is the Q-Fever Case Investigation form used in Indiana.
Q: What is Q-Fever?
A: Q-Fever is a bacterial infection caused by the Coxiella burnetii bacteria.
Q: What is the purpose of the Q-Fever Case Investigation form?
A: The purpose of the form is to collect information about individuals with Q-Fever for public health surveillance and response.
Q: Who should complete Form 51657?
A: Healthcare providers or public health professionals should complete the form when investigating Q-Fever cases in Indiana.
Q: Is the completion of Form 51657 mandatory?
A: Yes, the completion of Form 51657 is mandatory for healthcare providers and public health professionals investigating Q-Fever cases in Indiana.
Q: What information is required on Form 51657?
A: The form requires information about the case's demographics, symptoms, exposure history, and laboratory testing.
Q: How can the information on Form 51657 be used?
A: The information collected on the form is used for public health surveillance, investigation, and response to Q-Fever cases in Indiana.
Form Details:
- Released on July 1, 2004;
- The latest edition provided by the Indiana State Department of Health;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of State Form 51657 by clicking the link below or browse more documents and templates provided by the Indiana State Department of Health.
Download State Form 51657 Q-Fever Case Investigation - Indiana
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