Due to the fact that the surrounding is prone to any outbreak of some communicable diseases, most particularly those transmitted through air or what we call airborne illnesses, a healthy lifestyle or habit is crucial for this matter. Yet, there are some cases wherein these diseases are not only transmitted from place to place but also passed on from a person to another, until the whole society is affected with the disease or infection.

Therefore, in order to determine and understand the reasons behind the upsurge of these illnesses or diseases, medical or health professionals and practitioners conduct various kinds of research studies for each and every case that is encountered. You may also see free incident report forms

The nature of each is identified, the treatments to resolve these are uncovered, and the number of the different outbreaks is reduced. All of these are made possible with the use of case report forms. You may also like sample accident report form

Case Report Form Template

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Generic Case Report Form Sample

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Case Report Form Template

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What Are Case Reports?

Case reports are from clinical observations and researches that contain the summarized data and information that resulted from various kinds of conducted laboratory tests and/or examinations. These are the statistics of data that are simplified from intricate information into a comprehensible outline. By means of this, the report is made understandable and accessible by all, particularly the patients and all other people involved who do not understand the medical terms in the report.

These case report forms are technically designed for the authorized personnel or staffs to input or record all relevant data and information on each trial case subject. All details that are necessary for the completion of the report should be provided and specified.

Yet, before any laboratory tests are performed or conducted, the patients or the parents of each patient (if minors) are asked to sign the informed consent. An informed consent is one of the types of legal consent forms. This is also known as an authorization form from the patient or participant that they are giving their permission to the specified person or people to conduct a few tests and/or to release their information. The terms and conditions are specified in details in the individual participation agreement.

Below are few examples for case report forms that you may refer to as your reference or basis. In addition, there are also some basic tips and guidelines on how these report forms are utilized, filled out, and designed.

Standard Case Report Form Template

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Sample Case Report Form in DOC

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Interactive Case Report Form

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Confidential Case Report Form

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How Case Reports Are Utilized

Technically, these case report forms are often utilized when a patient is diagnosed with some disease, and that he or she is required to undergo some health assessment. This assessment is done in order for the medical practitioners to uncover every detail, and find the solution to avoid the flare-up or sudden outburst of the different health complications.

For this reason, they would list all data and information that are gathered from the different test results and finalize everything by utilizing the case report forms.

Due to the fact that these report forms are categorized, it is easier for the practitioners to identify where the information should be written or documented, thus, making all information in order and in an organize manner. It is also more convenient for each of them to locate a specific data by basing on the categories or the different parts of the form.

In addition, the results are recorded comprehensibly with the use of these case report form templates, and that everyone, even those who do not have any medical background, are able to understand what cases they are dealing with. You may also see sample incident report forms

Basically, these kinds of report forms are designed for an effective and efficient assessment of each encountered case and that not a single information is forgotten due to the fact that all necessary information to complete the case report are included in the form. Hence, the tips in filling out of case report forms must be taken note of.

How Case Report Forms Are Filled Out

Each and everyone must understand that these case reports are confidential. This is due to the fact that most information that are indicated in these reports can be used against the trial subject or the patient. For this reason, medical practitioners sometimes do not include the names of their patients in the form, unless the patient has given his or her authority to disclose this information.

Otherwise, the medical center will be held liable for any leakage of information from this confidential report. Nevertheless, below are some basic tips that could help you in filling out case report forms.

  • Do not hesitate to ask or call for some assistance when you need to clarify a few things.
  • All necessary information should be provided, most especially those required.
  • Ensure that all information are written legibly or comprehensibly to avoid any misinterpretation of the information. You may also like patient report forms
  • Certify or affirm that all information are true, correct, and accurate.
  • The form instructions must be strictly observed and adhered.
  • Make sure that all signatures from the authorized personnel and/or those who are involved are affixed in the report form.
  • The submission of the case report forms must be made according to the given deadline.
  • All data or information that are recorded or written in the report form should have a basis.
  • Only those who are authorized should have the access of each case report form.

Outbreak Case Report Form Sample

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Infection Case Report Form Template

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Invasive Case Report Form Sample

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Communicable Disease Case Report Form

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What Case Report Forms Are Composed Of

For an effective report for each cases conducted, here below is a list of all the essential information that composes the case report form:

  • The general information of the report
    • The case report status (either confirmed, suspect, or revoked)
    • The date of when the report form is filled out and submitted
    • The comment with regards to the final report
    • The name and contact number of the person completing the report form
    • The reporting source (either from or by a general practitioner, self-notification, hospital based practitioner, laboratory personnel, outbreak investigation, or other sources)
  • The demographic or patient information
    • The patient ID or number
    • The full name of the patient (the first, middle, and last)
    • The date of birth
    • The place of birth
    • The sex or gender
    • The exact and current residential address (including the city and the state)
    • The contact information (mobile and telephone)
    • The email address
    • The race and/or ethnicity
    • The name/s and contact number/s of contact person/s or the parent (if patient is still a minor)
  • The occupation or employment information
    • The position or work
    • The employer or company
    • The company address
    • The contact information of the employer or company
  • The consultations and clinical observation details
    • The date of the first consultation
    • The list of symptoms from the case reported
    • The date onset of the symptoms
    • The list of laboratory report or tests that were conducted
    • The specification of the specimens collected
    • The date of when the specimen are collected
    • The laboratory test results (either positive, negative, previously positive, not tested, or unknown)
    • The specification, comments, and details of the test results
    • The adverse reactions that resulted from the medical tests
    • The date of when the results are out or administered
    • The medical practitioner’s name and contact information, in cases there are some clarifications with regards to the medical assessment
  • The protective factors or medication information
    • The date of when medications begun
    • The list of medicines or medical intakes
    • The dosage and the frequency of each medication
    • The list or types of vaccination to be injected
    • The dosage for each vaccination
    • The remarks, comments, or additional information with regards to the vaccines
    • The vaccination status and history such as the past vaccines
    • The duration for the medication and/or vaccination
    • The additional comments
  • The hospitalization history and information
    • The date of when the patient was admitted or hospitalized
    • The hospital name
    • The discharge date (and time of the day)
    • The hospital registration or record number (if applicable)
    • The result or outcome from hospitalization (either died, recovered, or unknown)
    • The date of death (if patient had died)
    • The cause of patient’s death
    • The general practitioner’s or doctor’s name and contact information
    • The name of the discharge planning contact person and the contact number
    • The patient’s primary health care provider together with the contact number
    • The name of the agency or the facility reporting

The following above are few of the basic and standard information that often composes the case report form. For additional assessment, there are further information that are needed to complete the different cases. These information are as follows:

  • The physical examination results
  • The list of all risk factors for disease
  • The interview questionnaire
  • The feedback or comments regarding the interviews conducted
  • The investigation results or reports
  • The treatment or services referrals or referee report
  • The food intake history
  • The animal contact history
  • The medical history information
  • The environmental exposures
  • The travel history to know where the disease is exposed
  • The daily habit or lifestyle of the patient regarding to cleanliness and surroundings

All the possible factors that are caused by or could result from these different cases are investigated in order to determine how these can be resolved and prevented from being transmitted, and that an effective cure for each health complication will be uncovered. This is by means of digging deeper by interrogating about the past food or medical intakes, or the past travels or trips of the infected patient.

All these are required in order for the medical practitioners to have a better understanding with regards to the different case reports. In fact, they would often conduct or provide some survey forms to determine whether there are some other cases that are connected or linked to the current case report they are dealing with. This is also needed in order for them to know how fast the outbreak or flare-up is.

This is confirmed by basing on the results and the information documented in the report form. This is one of the main reasons why it is important that all cases are documented accordingly, most especially in such cases wherein they would be needing to compare past reports to the current ones.

Active TB Case Report Form

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Arboviral Disease Case Report Form

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Salmonellosis Case Report Form

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Latent TB Infection Case Report Form

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Wisconsin Lyme Disease Case Report

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How Case Report Forms Are Designed

Here below are few guidelines that you should take heed of, especially when you are designing a case report form.

  • The form should be organized with the specified parts in order to classify the information that are to be written in the ample spaces provided. You may also like damage report forms
  • The title should be written at the top part of the form in order for the patient or the person filling out the form to know what the form is all about.
  • You could make use of bold fonts in order to specify the title, the subtitles, the instructions, and the different parts or categories in the form.
  • The name of the company or the organization should also be specified in the form. This is in order to gain trust from the patients or participants. You may also like sample status report forms
  • The form instructions should be specified clearly and in few words in order to avoid misinterpretation.
  • The form should contain all the information that are required in completing the case report.
  • There should be ample spaces for filling out the information in the form. An example for this is the field for comments. You may also see service report forms
  • The form should only contain relevant questions and information.
  • It is more convenient if there are some check boxes for questions that require multiple answers.
  • The forms could be designed in two or more columns to make use of the spaces, for as long as all fields for information are organized. You may also like financial report forms
  • The form could be designed in a tabular style to avoid wrong input or misplaced information.

By taking note of each, you will be able to produce or generate an efficient report form. Therefore, take the time to peruse or study each general statement.

Nevertheless, these case report forms are utilized to study the different cases on each trial subject and to produce or generate an effective and efficient case report.

For the finalization of all data and information, it is ensured that all necessary or essential details are specified, complete, and accurate, thus, bringing the report to a success as they finalize all information from the conducted statistical analysis of each trial. Refer to the forms that are provided in this article to further understand case report forms. You may also see incident report sample

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