Measles Exposure Interview Form

Form Template

When a case of measles is confirmed or suspected, it is critical to identify and interview contacts exposed to measles.

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The virus causing the measles disease is highly contagious, and the infection can be devastating to high-risk patients. The Measles Exposure Interview Form app is an essential tool used by a health center to gather information about individuals at risk of measles. With the app, a health interviewer will ascertain exposure information that may require follow-up. The health interviewer will describe the original case of measles and thoroughly document all other potential contacts. The health interviewer will determine the patient's status of measles immunity based on vaccination records, blood test results indicating measles immunity, or prior history of the disease and assess symptoms and risk factors for infants, pregnant women or patients with other health complications. The app includes useful tables to ensure that interviewer is efficient and precise such as a chart for collecting information on symptoms of the infection over a period of time including a rash, high fever, and cough. Finally, the interviewer is provided with essential education and prevention protocol to promote both patient health and disease control in order to minimize the transmission of measles. Completed interviews and reports can be sent to health officials.

Features
  • Signature Capture
  • GPS
  • Image Capture
  • Conditional Fields
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

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