Disease / Condition-Specific Forms

Anthrax Meningitis (Aseptic)​
Babesiosis​​ Meningitis (Bacterial)
Botulism Meningococcal Disease
Botulism Infant MERS-CoV (PDF)
Brucellosis MERS-CoV (Word)
Carbapenem-resistant Enterobacteriaceae (CRE) Mumps (Updated)
Cholera and Other Vibrio Illnesses  (Form Guidance) Outbreak (See below)
Coronavirus, Novel  (Interim Form) Perinatal Hepatitis B 
Coronavirus, Novel  (Interim Form) Perinatal Hepatitis B Contact 
Cyclospora
Pertussis
Data and Specimen Handling (DASH) Pneumonia- Health Care Worker
Dengue Polio
Diphtheria
Psittacosis
Encephalitis
Q-Fever
Gastrointestinal Illness (Click Here for Directions)
Rickettsial (RMSF/Ehrlichiosis)
Haemophilus Influenzae
Rocky Mountain Spotted Fever
Hansen's Disease (Leprosy)
Rubella
Hantavirus
Rubella - Congenital
Hepatitis (Viral)
SARI/Enterovirus
Hepatitis C (Initial)
SARS
Hepatitis C (Supplemental)
Smallpox
Influenza, Novel  Tetanus
Influenza-Associated Pediatric Death
Toxic Shock Syndrome
Influenza (2009 H1N1) Adult Death
Trichinosis
Influenza (2009 H1N1) Clinical/ Pregnancy
Tularemia
Kawasaki Syndrome Printable Typhoid and Paratyphoid Fever
Kawasaki Syndrome Fillable
Vaccine Adverse Event Reporting System (VAERS)
Legionellosis - CDC 52.26 (Nov 2013)
Varicella
Legionellosis - DHMH Supp. (Jan 2014)
Varicella Death Investigation
Leptospirosis
Varicella Death Guidelines
Leprosy
Vibrio (Form Guidance)
Listeria Initiative
Viral Hemorrhagic Fever (VHF)
Lyme Disease
VHF - Ebola Supplement
Malaria​
West Nile Virus
​Measles​ Zika Interim Surveillance Form

 
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 PDF Word
Waterborne Illness Outbreak PDF Word