Reporting Forms

Initial Provider Disease Report EPI-2 (98.4 KB PDF)
 

This reporting form is to be used for most conditions as it is designed to track the collection of the information necessary to classify a case as confirmed, probable  or dropped before it is entered into the notifiable conditions' database.

Confidential Disease Report EPI-1 (78.3 KB PDF) 

This reporting form collects information for multiple cases on one piece of paper when that is appropriate. It is not appropriate for disease case reports from multiple reporters to be placed on the same sheet.

Additional Forms

• AFM Patient Summary Form (PDF, May 2021)
• Contaminated Sharps Injury Reporting Forms (PDF and Word)
• Varicella (Chickenpox) Reporting Form (PDF, 414 KB August 2023)
• HIV/STD Reporting Form