Hepatitis B Provider Case Report Form

The infection is a communicable disease spread when blood, semen, or another bodily fluid from a person infected with the virus enters the body of someone else. Symptoms could include abdominal pain, dark urine, or yellowing of the eyes. In patients with chronic Hepatitis B, serious complications can occur including liver failure or liver cancer which may result in the need for medication or a possible liver transplant. The Hepatitis B Provider Case Report Form app is used to document cases of acute and chronic Hepatitis B, as well as perinatal exposure to the disease. The report form is used to collect patient and clinical information including a checklist for signs and symptoms such as abdominal pain, nausea vomiting, and headache. The health care provider will organize all serologic testing for hepatitis B virus and indicate risk factors identifying pregnant women who are at risk of passing the infection to a newborn or identifying sex partners who may have also contracted the disease. The health care provider reporting the information or administering treatment for the disease will provide contact details, as well.