Form F 44151 PDF Details

Did you know that the Internal Revenue Service (IRS) requires tax-exempt organizations to file Form 990 annually? If your organization doesn't file this form, it could be subject to fines or revocation of its tax-exempt status. One such form is Form 44151, which is used by certain exempt organizations to report compensation paid to their key employees. Let's take a closer look at what this form is and who needs to complete it. Tax-exempt organizations are required to file Form 990 annually with the IRS to maintain their tax-exempt status; one such form is Form 44151, which is used by certain exempt organizations to report compensation paid to their key employees. This form should be completed by all tax-exempt organizations that have key employees whose annual compensation exceeds $100,000. The form requests information on the employee's name and address, job title, total annual compensation, and other benefits received. Completing this form can help ensure that your organization

QuestionAnswer
Form NameForm F 44151
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesF44151 dph 4151 form

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DEPARTMENT OF HEALTH SERVICES

STATE OF WISCONSIN

Division of Public Health

Wis.Stats. §. 252.05

F-44151 (Rev. 07/2019)

 

ACUTE AND COMMUNICABLE DISEASE CASE REPORT

PROVIDER

DISEASE OR CONDITION DATADEMOGRAPHIC DATA PATIENT INFORMATION

HEALTHCARE

LAB DATA

REPORTING

SOURCE

(REQUIRED)

Patient’s Name: (Last)

 

 

(First)

 

 

 

(M.I.)

 

 

 

Primary Language

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth (mm/dd/yyyy)

 

Age

 

Sex/Gender

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Male

 

 

Transgender: Female to Male

Transgender: Male to Female

 

 

 

 

 

Female

 

 

Transgender: Unspecified/Non-specific

Unknown

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Race:

 

 

 

 

 

 

 

 

 

 

 

Ethnicity:

 

 

American Indian or

Asian

Black or African

Hawaiian or Pacific

White

Other, Specify

Hispanic

Not Hispanic

Alaskan Native

 

American

Islander

 

 

 

 

 

 

or Latino

or Latino

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Patient’s Address

 

 

 

 

 

 

 

City

 

 

 

State

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

County of Residence

 

 

 

 

 

Home Phone

 

 

Cell Phone

 

 

 

 

 

 

 

 

Patient’s Employer & Occupation or School, Day Care, Institution

 

 

Patient’s Parent/Guardian if patient is a minor (not needed for STD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is Patient Pregnant?

No Yes If yes, Due date (mm/dd/yyyy)

Healthcare Provider

Phone

 

 

Address of Provider (Street, City, State, and Zip)

Reportable Disease/Organism

Date of Illness Onset

 

 

Outbreak Related?

 

 

 

 

 

Asymptomatic

 

 

 

Yes

No

Unknown

 

 

 

 

 

 

 

Underlying Medical Condition(s)?

 

Patient Hospitalized?

 

Patient Died of this Illness?

Unknown

No

Yes, specify:

 

Yes

No

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

Specimen Type(s)

Date(s) of Collection

Test(s) Performed

Test Results

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attach lab report if available.

Name of Reporting Entity

 

Date Reported to Public Health

 

 

 

 

Address (Street, City, State, and Zip)

Phone No.

 

Fax No.

 

 

 

 

F-44151 (Rev. 07/2019)

Page 2 of 2

Information for Completing

ACUTE AND COMMUNICABLE DISEASE CASE REPORT

Wisconsin Stat. § 252.05 and Wis. Admin. Code ch. DHS 145 require reporting of communicable diseases.

For further information see Wis. Admin. Code ch. DHS 145.

Reporting and Contact Information

Description of diseases for each of the reporting categories is available from the Department of Health Services, Disease Reporting webpage https://www.dhs.wisconsin.gov/disease/diseasereporting.htm

Category I diseases are of urgent public health importance and require the initial notification to be provided to the public health agency by telephone within 24 hours of disease suspicion or confirmation. This category includes outbreaks of any acute illness regardless of whether cause or source is known.

Category II diseases are reportable by fax, mail, or electronic reporting to the health officer or their designee located in the local public health department of the patient’s place of residence within 72 hours of identification of the disease.

Listing of Wisconsin Local Health Officers https://www.dhs.wisconsin.gov/lh-depts/counties.htm

Category III conditions must be reported directly to the Bureau of Communicable Diseases state epidemiologist.

Using this form to notify public health agencies of a reportable disease or condition:

1.Complete the “Demographic Data,” “Disease or Condition Data,” “Lab Data,” and “Reporting Source” sections for ALL diseases.

2.Fax or mail form and lab results (if available) to public health agency. Local and tribal health agency contact information available at https://www.dhs.wisconsin.gov/lh-depts/counties.htm

•Copies of Infectious Disease Reports may be mailed to: Bureau of Communicable Diseases,

1 West Wilson St, Room 272, Madison, WI 53703, or faxed to: 608-264-6820.

•Copies of toxicologic and environmental disease reports may be mailed to: Bureau of Environmental and

Occupational Health, 1 West Wilson St, Room 150, Madison, WI 53703, or faxed to: 608-267-4853.

Most disease reports are now received electronically through the Wisconsin Electronic Disease Surveillance System (WEDSS). Healthcare providers and laboratories can register to report electronically through WEDSS https://www.dhs.wisconsin.gov/wiphin/wedss.htm.

Questions about reporting diseases may be directed to:

Bureau of Communicable Diseases

Bureau of Environmental and Occupational Health

Phone: 608-267-9003

Phone: 608-266-1120

How to Edit Form F 44151 Online for Free

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As for the fields of this specific PDF, this is what you should consider:

1. First of all, once filling out the Form F 44151, start with the form section that features the subsequent fields:

Ways to complete Form F 44151 portion 1

2. Now that this segment is done, it is time to insert the needed specifics in A T A D N O T D N O C R O E S A E, A T A D B A L, G N T R O P E R, E C R U O S, Underlying Medical Conditions, Unknown, Yes specify, Comments, Patient Hospitalized, Patient Died of this Illness, Yes, Yes, Specimen Types, Dates of Collection, and Tests Performed in order to move forward further.

Writing section 2 of Form F 44151

Be extremely attentive when completing G N T R O P E R and Tests Performed, since this is where many people make mistakes.

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