Medium

Available on

Apple Android Windows

Hansen's Disease Surveillance (formerly Leprosy Surveillance, CDC 52.18) Mobile App

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and is intended for use by health professionals only. Reportable Diseases and Conditions for specific diseases and conditions are mandated by state laws and regulations to be reported by healthcare providers and laboratories to local health officers. The Hansen's Disease Surveillance (formerly Leprosy Surveillance, CDC 52.18) mobile app provides an easy to complete paperless version of the mandated case report form specific to The Hansen's Disease/ Leprosy. The app is filled out using a smartphone or tablet. This GoCanvas app can be made HIPAA compliant and is ideal for Disease Surveillance and Reporting.

The Center for Disease Control, national centers, children’s hospital, public health and local health departments urge health care providers to promptly report infectious diseases as well as virus infections. It is important for patient safety. Pregnant women, immigrant children, illegal immigrants and travelers are at a greater risk for communicable diseases and birth defects from lack of infection control and virus transmission. This app is specific to Hansen's Disease/ Leprosy but please don’t hesitate to report any suspicious respiratory illness, flu, rash, pneumonia or virus infection. Timely reporting can stop outbreaks.

  • Lendlease
  • The Cooperative
  • PG&E
  • oxy
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Hansen's Disease Surveillance (formerly Leprosy Surveillance, CDC 52.18) Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico dropdown

    1 Reporting State

  • Ico date

    2 Date of Report

  • Ico textbox

    3 Social Security Number (optional)

  • Ico textbox

    4 Patient Name: (Last) (First) (Middle)

  • Ico statictext

    5 Present Address:

  • Ico textbox

    Street

  • Ico textbox

    City

  • Ico textbox

    County

  • Ico dropdown

    State

  • Ico integer

    Zip

  • Ico statictext

    6 Place of Birth:

  • Ico dropdown

    State

  • Ico textbox

    County

  • Ico textbox

    Country

  • Ico date

    7 Date of Birth:

  • Ico dropdown

    Sex:

  • Ico dropdown

    8 Race/Ethnicity:

  • Ico date

    Date Entered U.

  • Ico date

    10 Date of Onset of Symptoms:

  • Ico date

    11 Date Leprosy First Diagnosed:

  • Ico dropdown

    12 Initial Diagnosis in:

  • Ico dropdown

    13 Type of Leprosy: (IC - 9-CM Code)

  • Ico statictext

    14 Diagnosis of Disease:

  • Ico dropdown

    Was biopsy performed in U.

  • Ico date

    Date

  • Ico textbox

    Result

  • Ico dropdown

    Skin Smear

  • Ico date

    Date

  • ...and More!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

Malaria Case Report California CDPH 8657

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Salmonellosis Case Report California ...

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Tularemia Case Report California CDPH...

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Typhus and Other Non-Spotted Fever Ri...

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Zika Case Report California CDPH 8680

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Practitioner Disease Report Form

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Creutzfeldt-Jakob Disease (CJD) and T...

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Reportable Disease Report

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

More Information