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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

PDF

06/2008
Anthrax Word PDF 01/2008

PDF

06/2008
Arboviral Disease Word PDF 01/2008

PDF

07/2008

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
Chancroid       PDF 06/2008
Chlamydia       PDF 06/2008
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
Gonorrhea       PDF 06/2008
Granuloma       PDF 06/2008

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

05/2008
Herpes, Genital       PDF 06/2008
HIV/AIDS Word PDF 08/2007 PDF 06/2008
Legionellosis Word PDF 01/2008

PDF

07/2008
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
Lymphogranuloma       PDF 06/2008
Malaria Word PDF 01/2008

PDF

04/2008
Measles Word PDF 01/2008

PDF

05/2008
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

07/2008
Prion Diseases, Human (CJD) Word PDF 01/2008 PDF 11/2007
Psittacosis Word PDF 01/2008

PDF

05/2008
PSP (Paralytic Shellfish Poisoning) Word PDF 01/2008

PDF

01/2008
Q Fever Word PDF 01/2008

PDF

05/2008
Rabies, Human Word PDF 01/2008

PDF

07/2008
Rabies Post-Exposure Prophylaxi (PEP) Word PDF 01/2008

PDF

06/2008
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
Syphilis       PDF 06/2008
Tetanus Word PDF 01/2008

PDF

06/2008
Trichinosis Word PDF 01/2008

PDF

02/2008

Tuberculosis (TB) Word PDF 12/2002

PDF

06/2008
Tularemia Word PDF 01/2008

PDF

12/2007
Typhoid fever Word PDF 01/2008

PDF

10/2002
Typhus Word PDF 01/2008

PDF

04/2008
Unexplained Critical Illness or Death Word PDF 01/2008

PDF

06/2008
Vibriosis Word PDF 01/2008

PDF

09/2007
West Nile Virus Disease Word PDF 01/2008

PDF

07/2008
West Nile Virus, CDC enhanced surveillance Word PDF 07/2008    
Yellow Fever Word PDF 01/2008

PDF

07/2008
Yersiniosis Word PDF 01/2008

PDF

02/2008


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Communicable Disease Epidemiology
Office of Epidemiology
Washington State Department of Health
MS: K17-9, 1610 NE 150th St.
Shoreline, WA 98155-9701

Consultation and technical assistance are available to local health jurisdictions in Washington State:
Phone (206) 418-5500

FAX (206) 418-5515

24-hour contact (inside Washington State only)  1-877-539-4344

Washington residents can contact their local health jurisdictions for assistance


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