Florida Practitioner Disease Report Form

Form Template

To protect public health from infectious disease outbreaks, healthcare providers are required to report some communicable diseases.

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The Florida Practitioner Disease Report Form app can be easily completed by healthcare providers to communicate an infectious disease case to local health departments. The physician will record patient information and insurance, and provider information, and then describe the medical condition, diagnosis and treatment, laboratory testing, and vaccination status. The app lists all reportable diseases and conditions in Florida. The physician can check from the list that includes measles, diphtheria, and human papillomavirus HPV. This reporting form app will help health care providers to thoroughly document infectious disease and promptly notify the department of health.

Features
  • Image Capture
  • Conditional Fields
  • Submission Editing
  • Reference Data
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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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