Kansas Reportable Disease Form

Form Template

Local health departments should be alerted to the incidence of a communicable disease that could threaten public health.

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Infectious disease control and prevention is effective when cases are identified, reported, and contacts interviewed. With the Kansas Reportable Disease Form app, a medical professional or clinic can report an infectious disease to the local health department. With the app, the medical professional can describe patient demographics and potential exposure including any high-risk settings visited by the patient. Next, the healthcare provider will provide illness or condition information such as the suspected illness, symptoms, onset date, and whether there were complications that required hospitalization. The app user should include any laboratory tests performed or specimens collected and the results, along with details of the treatment type and duration, if applicable.

Features
  • Signature Capture
  • Image Capture
  • Conditional Fields
  • Submission Editing
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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