Disease / Condition-Specific Forms

Anthrax
Meningitis (Bacterial)
Babesiosis​​ Meningococcal Disease 
Botulism Meningococcal Disease Supplemental Form (NEW)
Botulism Infant MERS-CoV (PDF)
Brucellosis MERS-CoV (Word)
Carbapenem-resistant Enterobacteriaceae (CRE) Mumps (Updated)
Chlamydia​ Outbreak (See below)
Cholera and Other Vibrio Illnesses  (Form Guidance) Perinatal Hepatitis B 
Coronavirus, Novel  (Interim Form) Perinatal Hepatitis B Contact 
Cyclosp​ora
Pertussis
Data and Specimen Handling (DASH)
Pneumonia- Health Care Worker
Dengue
Polio
Diphtheria
Psittacosis
Encephalitis
Q-Fever
Gastroenteritis ​​(Click Here for Instructions)
Rickettsial (RMSF/Ehrlichiosis)
Gonorrhea​ Rocky Mountain Spotted Fever
Haemophilus Influenzae
Rubella
Hansen's Disease (Leprosy)
Rubella - Congenital
Hantavirus
SARI/Enterovirus
Hepatitis A Acute (Sept 2018)​
SARS
Hepatitis B Acute Smallpox
Hepatitis C (Initial)
Syphilis
Hepatitis C (Supplemental)​
Tetanus
Influenza, Novel 
Toxic Shock Syndrome
Influenza-Associated Pediatric Death
Trichinosis
Influenza (2009 H1N1) Adult Death
Tularemia
Influenza (2009 H1N1) Clinical/ Pregnancy
Typhoid and Paratyphoid Fever
Kawasaki Syndrome Printable
Vaccine Adverse Event Reporting System (VAERS)
Kawasaki Syndrome Fillable
Varicella
Legionellosis - CDC 52.26 (Nov 2013)
Varicella Death Investigation
Legionellosis - MDH Supplemental (Dec 2018)
Varicella Death Guidelines
Leptospirosis
Vibrio (Form Guidance)
Leprosy
Viral Hemorrhagic Fever (VHF)
Listeria Initiative​
VHF - Ebola Supplement
Lyme Disease
West Nile Virus
Malaria​​
Zika Virus
Measles​

Meningitis (Aseptic)​

 
Long-Term Care Facility Forms Adobe
Acrobat
Microsoft
Word
Gastroenteritis Outbreak PDF Word
Respiratory Outbreak PDF Word
Scabies Outbreak PDF Word
Drug Resistant Organism Outbreak PDF Word
     
Foodborne Outbreak Forms    
     
National Outbreak Reporting System (NORS) Form 52.13
PDF
National Outbreak Reporting System (NORS) Form 52.13 Guidance PDF  
NORS Guidance Appendices:
 
​​Appendix A: Mode of Transmission for Certain Beverages and Foods or Drinks Containing Ice
PDF
​Appendix B: Reporting Foodborne and Animal Contact Multistate Exposure and Residency Outbreaks
PDF
​​Appendix C: Freedom of Information Act (FOIA) Requests and Other Requests for NORS Data
PDF
​​Appendix D: ​NORS Guidance for Contributing Factors (CF) in Foodborne Outbreak Reports
PDF
​​Appendix E: Available Picklist Values    ​ 
PDF
     
Other Forms    
     
Daycare Facility Outbreak PDF Word
Hospital Outbreak (Excluding Gastroenteritis) PDF Word
Gastroenteritis Outbreak at a Hospital PDF Word
Pertussis Outbreak PDF Word​
School Outbreak (General)
School Outbreak (Influenza or ILI)
PDF
PDF
Word
Word
Waterborne Illness Outbreak PDF Word