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Communicable Disease Control

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Utah Public Health Lab

 


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DISEASE PLANS, REPORT FORMS and FACT SHEETS

Communicable Disease Rule (R386-702)

Confidential Morbidity Report (CMR) Form

NOTICE
  • Many of the disease investigation forms listed here are currently being reviewed and updated.
  • Investigation forms listed here may not be as current as those found in UTNEDSS/TriSano. Some of these investigation forms may be missing questions when compared to those in UTNEDSS/TriSano.
  • The date the investigation form was last updated is listed directly under the link pointing to the investigation form.
  • For those without access to UTNEDSS/TriSano, use the most current investigation form listed below.

NOTE: This notice does not apply to enteric disease forms.

 

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Disease Name
Fact Sheet
Disease Plan
Disease Form(s)
AIDS/HIV
Fact Sheet
Disease Plan
(October 2007)
Case Report Form
(June 2011)
Amebiasis
Fact Sheet
Disease Plan
(December 2010)
Case Report Form
(December 2008)
Anthrax
Disease Plan
(February 2008)
Case Report Form
(May 2008)
Arboviral (SLE, Dengue, Yellow Fever)
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Aseptic Meningitis
Disease Plan
(October 2007)
Avian Influenza (H5N1)  
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Bacterial Meningitis
Disease Plan
(March 2009)
Case Report Form
(May 2008)
Bed Bugs
more information		    
Botulism

Infant Botulism Fact Sheet

Non-Infant Botulism Fact Sheet
Disease Plan
(December 2010)

(Infant) Case Report Form
(December 2010)

(non-Infant) Case Report Form (January 2008)
Brucellosis
Disease Plan
(Februayr 2010)
Case Report Form
(November 2010)
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Campylobacteriosis
more disease information
Disease Plan
(April 2011)
Case Report Form
(November 2010)
Chagas disease    
Chancroid  
Disease Plan
(October 2007)
Contact the UDOH STD Program for a copy of the report form for this disease
Chicken Pox
more disease information
Disease Plan
(April 2010)
Case Report Form
(April 2010)
Chlamydia
Disease Plan
(October 2007)
Case Report Form
(January 2012)
Cholera (Vibriosis)
Disease Plan
(December 2010)

UDOH Case Report Form
(December 2008)

CDC Surveillance Report Form (August 2007)

(complete both forms)
Coccidioidomycosis
Disease Plan
(March 2011)
Congenital Rubella Syndrome
Disease Plan
(October 2007)
Colorado Tick Fever
more disease information
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Confidential Morbidity Report (CMR)    
Creutzfeldt Jakob Disease (CJD)
more disease information

CJD (Classic) Fact Sheet

CJD (Variant) Fact Sheet
Disease Plan
(October 2007)
Case Report Form
(May 2008)

Cryptosporidiosis
more disease information
Disease Plan
(August 2010)

Case Report Form
(November 2010)

Crypto Mini Form
(December 2008)
Cyclosporiasis
Disease Plan
(August 2010)
Case Report Form
(December 2008)
Cytomegalovirus    
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Dengue
Disease Plan
(January 2011)
Diphtheria
Disease Plan
(February 2010)
Case Report Form
(April 2010)
Ehrlichiosis
more disease information
Disease Plan
(October 2007)
Encephalitis
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Enteric Diseases    
Echinococcosis
Disease Plan
(October 2007)
Case Report Form
(December 2008)
E. coli (STEC)
Disease Plan
(December 2010)
Case Report Form
(August 2010)
Fifth Disease    
Foodborne, Person-to-Person, and Animal Contact Outbreak    
Fusarium keratitis    
Genital Warts
(Human Papilloma virus)		    
Giardiasis
Disease Plan
(August 2010)
Case Report Form
(December 2008)
GI Cluster    

Case Report Form icon
(September 2010)

Case Report Form pdficon
(September 2010)
Gonorrhea
Disease Plan
(October 2007)
Case Report Form
(January 2012)
Group A Streptococcus (Invasive)
Disease Plan
(October 2007)
Group B Streptococcus (Invasive)
Disease Plan
(October 2007)
Case Report Form
(May 2008)
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Haemophilus influenzae Infection
Hib vaccine information
Disease Plan
(March 2011)
Case Report Form
(October 2007)
Hansen's Disease (Leprosy)
Disease Plan
(October 2010)
Hantavirus Pulmonary Syndrome
more disease information
Disease Plan
(October 2007)
Head Lice (Pediculosis)
more information		    

Herpes

    
Herpes Dermatitis    
Hepatitis A
Disease Plan
(October 2007)
Case Report Form
(December 2008)
Hepatitis B
Disease Plan
(October 2007)
Hepatitis C
Disease Plan
(October 2007)

Hepatitis C Case Report Form (Acute) (May 2008)

Hepatitis C Case Report Form (Chronic) (May 2008)
Hepatitis D    
Case Report Form
(May 2008)
Hemolytic Uremic Syndrome (HUS)
Disease Plan
(April 2011)
Case Report Form
(November 2010)

Supplemental Form
(December 2008)
HIV/AIDS
Disease Plan
(October 2007)
Case Report Form
(June 2011)
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Infant Botulism
Disease Plan
(December 2010)
Case Report Form
(December 2010)

Influenza
more disease information

Disease Plan
(October 2010)

Influenza-Associated Hospitalization Case Report Form (October 2007)

Influenza-Associated Hospitalized Person Case Report Form for Providers (July 2008)

Influenza-Associated Pediatric Death Case Report Form (May 2008)

Instructions for the Forms
Invasive Streptococcal (Other)  
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Kawasaki Syndrome    
Legionellosis
more disease information
Disease Plan
(October 2007)
Case Report Form
(January 2011)
Leprosy (Hansen's Disease)
Disease Plan
(October 2010)
Lice (Head Lice, Pediculosis)
more information		    
Listeria
more disease information
Disease Plan
(August 2010)
Lyme Disease
more disease information
Disease Plan
(April 2010)
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Malaria
Disease Plan
(October 2007)
Measles (Rubeola)
more disease information
Disease Plan
(April 2011)
Case Report Form
(April 2010)
Meningitis (Viral/Aseptic)
Disease Plan
(October 2007)
Meningitis (Bacterial)
Disease Plan
(March 2009)
Meningococcal
more disease information
Disease Plan
(February 2008)

Case Report Form
(May 2008)
Mononucleosis Infectious    
Monkeypox
more disease information		    
Morbidity Card (CMR)    
MRSA
more disease information		    
Mumps
Disease Plan
(May 2010)
Case Report Form
(May 2010)
Norovirus
more disease information

Case Report Form
(December 2008)

Contact the Unified State Laboratories: Public Health before submitting lab form.

Norovirus Testing Guidance

Norovirus Lab Form

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Pandemic Influenza
more disease information
      
Pelvic Inflammatory Disease (PID)  
Disease Plan
(October 2007)
Contact the UDOH STD Program for a copy of the report form for this disease
Pertussis
more disease information

Fact Sheet

Fact Sheet for Clinicians

Information for Close Contacts
Disease Plan
(November 2010)
Plague
Disease Plan
(October 2007)
Case Report Form
(May 2008)

Pneumococcal Disease
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Polio
Disease Plan
(June 2010)
Case Report Form
(June 2010)
Psittacosis
Disease Plan
(February 2011)
Case Report Form
(May 2008)
Q Fever
Disease Plan
(October 2007)
Case Report Form
(May 2008)
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Rabies
more disease information
Disease Plan
(October 2007)
Raccoon Roundworm (Baylisascaris procyonis)    
Relapsing Fever    
Respiratory Syncytial virus (RSV)
    
Reye Syndrome    
Rheumatic Fever    
Rocky Mountain Spotted Fever
more disease information
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Rubella (German Measles)
Disease Plan
(August 2010)
Case Report Form
(May 2008)
Salmonellosis
more disease information
Disease Plan
(August 2010)
Case Report Form
(March 2011)
Salmonellosis, Repitle-Associated    

SARS
more disease information
Disease Plan
(October 2007)
Scabies
more disease information		    
Shigellosis
Disease Plan
(August 2010)
Case Report Form
(December 2008)
Shiga-Toxin Producing E. coli (STEC/EHEC)
Disease Plan
(December 2010)
Case Report Form
(March 2011)
Smallpox (Variola)

Disease Plan
(October 2007)

Smallpox Vaccine Plan (October 2007)
Case Report Form
(May 2008)
St. Louis Encephalitis (SLE)
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Stachybotrys (Corda 18327)    
Staphylococcus aureus with resistance to vancomycin (VRSA/VISA)
more disease information

Fact Sheet (CDC)

Fact Sheet for Clinicians (UDOH)
Disease Plan
(October 2007)
Streptococcal Infections (Group A)
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Streptococcal Infections (Group B)
Disease Plan
(October 2007)
Streptococcal Infections (Other)
Disease Plan
(October 2007)
Case Report Form
(May 2008)

Streptococcus pneumoniae
Disease Plan
(October 2007)
Streptococcal Toxic Shock Syndrome (STSS)
Disease Plan
(October 2007)
  
Swimmers Itch    
Syphilis
Disease Plan
(October 2007)
Case Report Form
(January 2012)
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Tetanus
Disease Plan
(October 2007)
Tick-Borne Diseases  
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Toxic Shock Syndrome (TSS)
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Trichinosis
Disease Plan
(April 2011)
Case Report Form
(December 2008)
Tuberculosis (TB)
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Tularemia
more disease information
Disease Plan
(July 2011)
Case Report Form
(May 2008)
Typhoid Fever
Disease Plan
(August 2010)

UDOH Typhoid Case Report Form
(December 2008)

CDC Typhoid and Paratyphoid Fever Case Report Form
Vancomycin Resistant Enterococci (VRE)    
Vancomycin Resistant Staphylococcus aureus (VRSA)
more disease information

Fact Sheet

Fact Sheet for Clinicians (UDOH)
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Varicella (Chickenpox)
more disease information
Disease Plan
(April 2010)
Case Report Form
(April 2010)
Vibrio Illness
Disease Plan
(December 2010)

UDOH Case Report Form
(December 2008)

CDC Surveillance Report Form (August 2007)

(complete both forms)
Viral Hemmorhagic Fever (VHF)  
Disease Plan
(October 2007)
  
Viral Meningitis
Disease Plan
(October 2007)

Waterborne Disease Outbreak		  
West Nile Virus
more disease information
Disease Plan
(October 2007)
Case Report Form
(May 2008)
"Wrestlers Rash"
more disease information		    
Yellow Fever
Disease Plan
(October 2007)
Case Report Form
(May 2008)
Yersiniosis  
Case Report Form
(December 2008)

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Updated 09/08 tj