Reporting Forms

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Communicable Disease Reporting Forms

Epi2
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.
 

Epi-1


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.


 

AFM Patient Summary Form (PDF, May 2021)

Contaminated Sharps Injury Reporting Forms (PDF and Word)

Varicella (Chickenpox) Reporting Form (PDF, 361 KB March 2021)

HIV/STD Reporting Forms
 

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