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Other links
concerning Notifiable Conditions |
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Posters |
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Associated Programs |
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Notifiable Condition Reporting
Forms and Guidelines
for Local Health Departments
New
standardized notifiable condition reporting forms and
guidelines for local public
health departments are now available for the following notifiable
conditions. Additional forms for foodborne illnesses can be
found on the Disease of Foodborne
Origin page. For additional information on how to report a notifiable condition, please see
How to
Report a Notifiable Condition.
|
Condition |
Reporting Forms
(revision date) |
Guidelines
(revision date) |
|
Animals Bites |
Word |
PDF |
01/2008 |
(none) |
|
Anthrax |
Word |
PDF |
01/2008 |
PDF
HTM |
10/2002 |
|
Arboviral Disease |
Word |
PDF |
01/2008 |
PDF |
02/2008 |
|
Botulism, Foodborne |
Word |
PDF |
01/2008 |
PDF |
09/2007 |
|
Botulism, Infant |
Word |
PDF |
01/2008 |
PDF |
09/2007 |
|
Botulism, Wound |
Word |
PDF |
01/2008 |
PDF |
09/2007 |
|
Brucellosis |
Word |
PDF |
01/2008 |
PDF |
01/2008 |
|
Campylobacterosis |
Word |
PDF |
01/2008 |
PDF |
09/2007 |
|
Cholera |
Word |
PDF |
01/2008 |
PDF |
01/2008 |
|
Creutzfeldt-Jakob disease (CJD) |
(see
Prion Diseases, Human) |
|
Cryptococcal Disease |
Word |
PDF |
02/2008 |
(none) |
|
Cryptosporidiosis |
Word |
PDF |
01/2008 |
PDF
HTM |
10/2002 |
|
Cyclosporiasis |
Word |
PDF |
01/2008 |
PDF |
03/2008 |
|
Diphtheria |
Word |
PDF |
01/2008 |
HTM |
10/2002 |
|
Enterohemorrhagic E. coli |
Word |
PDF |
01/2008 |
PDF |
10/2007 |
|
Giardiasis |
Word |
PDF |
01/2008 |
PDF
HTM |
10/2002 |
|
Gunshot |
Word |
PDF |
03/2006 |
HTM |
08/2007 |
|
Haemophilus Influenzae |
Word |
PDF |
01/2008 |
HTM |
01/2008 |
|
Hantavirus Pulmonary Syndrome |
Word |
PDF |
01/2008 |
PDF |
10/2007 |
|
Hemolytic
Uremic Syndrome (HUS) |
Word |
PDF |
01/2008 |
PDF |
10/2007 |
|
Hepatitis A,
acute |
Word |
PDF |
02/2008 |
PDF |
01/2008 |
|
Hepatitis B,
acute |
Word |
PDF |
02/2008 |
HTM |
10/2006 |
|
Hepatitis B,
perinatal |
Word |
PDF |
02/2008 |
(refer to
Hepatitis B) |
|
Hepatitis B
and C, chronic |
Word |
PDF |
02/2008 |
(refer to
Hepatitis B or C) |
|
Hepatitis C,
acute |
Word |
PDF |
02/2008 |
HTM |
10/2002 |
|
Hepatitis,
Unspecified |
Word |
PDF |
02/2008 |
PDF
HTM |
10/2002 |
|
HIV/AIDS |
Word |
PDF |
08/2007 |
HTM |
12/2007 |
|
Legionellosis |
Word |
PDF |
01/2008 |
PDF
HTM |
10/2002 |
|
Leptospirosis |
Word |
PDF |
01/2008 |
PDF |
05/2008 |
|
Listeriosis |
Word |
PDF |
01/2008 |
PDF |
10/2007 |
|
Lyme Disease |
Word |
PDF |
01/2008 |
PDF |
02/2008 |
|
Malaria |
Word |
PDF |
01/2008 |
PDF |
04/2008 |
|
Measles |
Word |
PDF |
01/2008 |
HTM |
08/2005 |
|
Meningococcal Disease |
Word |
PDF |
01/2008 |
PDF |
05/2008 |
|
Mumps |
Word |
PDF |
01/2008 |
PDF |
03/2008 |
|
Neurologic
Syndrome |
Word |
PDF |
01/2008 |
(none) |
|
Other
Conditions |
Word |
PDF |
01/2008 |
(none) |
|
Pertussis |
Word |
PDF |
04/2008 |
PDF |
12/2007 |
|
Plague |
Word |
PDF |
01/2008 |
PDF |
01/2008 |
|
Polio |
Word |
PDF |
01/2008 |
PDF
HTM |
10/2002 |
|
Prion Diseases, Human
(CJD) |
Word |
PDF |
01/2008 |
PDF |
11/2007 |
|
Psittacosis |
Word |
PDF |
01/2008 |
PDF
HTM |
10/2002 |
|
PSP (Paralytic Shellfish Poisoning) |
Word |
PDF |
01/2008 |
PDF |
01/2008 |
|
Q Fever |
Word |
PDF |
01/2008 |
PDF
HTM |
10/2002 |
|
Rabies, Human |
Word |
PDF |
01/2008 |
PDF |
05/2008 |
|
Rabies Post-Exposure Prophylaxi
(PEP) |
Word |
PDF |
01/2008 |
PDF |
12/2007 |
|
Rare diseases of public health
significance |
Word |
PDF |
01/2008 |
PDF |
03/2008 |
|
Rash illness |
Word |
PDF |
01/2008 |
(none) |
|
Relapsing Fever |
Word |
PDF |
01/2008 |
PDF |
12/2007 |
|
Rubella |
Word |
PDF |
01/2008 |
PDF
HTM |
10/2002 |
|
Salmonellosis |
Word |
PDF |
01/2008 |
PDF |
10/2007 |
|
Shigellosis |
Word |
PDF |
01/2008 |
PDF |
10/2007 |
|
Tetanus |
Word |
PDF |
01/2008 |
PDF
HTM |
10/2002 |
|
Trichinosis |
Word |
PDF |
01/2008 |
PDF |
02/2008 |
|
Tuberculosis (TB) |
Word |
PDF |
12/2002 |
PDF
HTM |
10/2002 |
|
Tularemia |
Word |
PDF |
01/2008 |
PDF |
12/2007 |
|
Typhoid fever |
Word |
PDF |
01/2008 |
PDF
HTM |
10/2002 |
|
Typhus |
Word |
PDF |
01/2008 |
PDF |
04/2008 |
|
Unexplained Critical Illness or
Death |
Word |
PDF |
01/2008 |
PDF
HTM |
10/2002 |
|
Vibriosis
|
Word |
PDF |
01/2008 |
PDF |
09/2007 |
|
West Nile Virus Disease |
Word |
PDF |
01/2008 |
PDF
HTM |
03/2008 |
|
Yellow Fever |
Word |
PDF |
01/2008 |
PDF |
03/2008 |
|
Yersiniosis |
Word |
PDF |
01/2008 |
PDF |
02/2008 |
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