HCV in the USA
• Physician’s name and phone number | • Date of diagnosis | |
• Name, institution, and phone number of person reporting | • Symptoms • Date of onset of symptoms |
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• Disease or condition | • Lab results: ALT, HBsAg, anti-HCV, specimen site, collection date. | |
• Patient’s complete name, address, phone, county, date of birth, race, sex, last five digits of social security number | • Patient status: Pregnancy status, In childcare, food-handler, health care worker, childcare worker, nursing home, prisoner/detainee, travel in last 4 weeks. | |