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Oregon Notifiable Disease Case Report Forms

Instructions

  • Please fax the first part of the form (demographic information) to ACDP at 971-673-1100 as soon as possible, even if you have not yet completed the case investigation.
  • For reportable diseases lacking Oregon-specific investigative guidelines or case report forms, please contact the epidemiologist on call for assistance at 971-673-1111

Download Forms

NOTE: Forms are updated periodically. To ensure you have the most current version, we strongly recommend using Orpheus or DUDE.

Disease
Form
Last
Updated
Synched w/
 Orpheus?
Anaplasmosis - CDC form No
Animal Bites and Rabies 06/2003 No
Anthrax 04/2013 No
Babesiosis - CDC form 04/2015 No
Botulism 05/2013 No
Brucellosis - CDC form
No
Campylobacteriosis 07/2015 Yes
Carbapenem-resistant Enterobacteriaceae 06/2016 No
Chikungunya - Draft form 07/2014 No
Cholera - See Vibrio infection, below
Coccidioidomycosis Valley Fever - CDC form No
Colorado tick fever - CDC form   No
Confidential Oregon Morbidity Report 11/2015 No
Cryptococcus gattii - CDC form 04/2014 No
Cryptosporidiosis 10/2014 Yes
Cyclosporiasis 12/2004 No
Diphtheria 06/2003 No
Ehrlichiosis - CDC form
No
Escherichia coli O157 07/2015 Yes
Giardiasis 10/2014 Yes
Gonorrhea 01/2014 No
Haemophilus influenzae 09/2012 Yes
Hantavirus Pulmonary Syndrome Screening Form - CDC form 08/2002 No
HCV testing pilot study 01/2016 No
HCV testing pilot study - Spanish 10/2010 No
Hepatitis A 11/201 Yes
Hepatitis B acute 01/2015 Yes
Hepatitis B chronic 03/2010 No
Hepatitis B Perinatal Case Management Form 09/2006 No
Hepatitis C acute 01/2015 Yes
Hepatitis C chronic 01/2015 Yes
Hepatitis E 07/2011 No

HIV Infection

 

No
Influenza-related Hospitalizations 11/2016 No
Legionellosis 11/2003 No
Listeriosis 01/2004 No
Listeriosis Supplement - CDC form 4/2016 No
Lyme Disease 6/2003 No
Malaria 1/2017 Yes
Measles 4/2015 Yes
Meningococcal Disease 3/2007 No
Mumps 4/2015 Yes
Nontuberculous Mycobacterium (NTM) - Extrapulmonary 10/2014 Yes
Novel Influenza A, such as H5N1 or H7N9 11/2016 No
Pertussis 04/2015 Yes
Plague - CDC form 2016 No
Psittacosis 06/2003 No
Q-Fever - CDC form 02/2008 No
Rabies and Animal Bites 06/2003 No
Rickettsial Tick-borne Diseases - CDC form 05/2008 No
Rocky Mountain Spotted Fever - CDC form   No
Rubella 07/2008 No
Salmonellosis 02/2016 Yes
SARS 01/2005 No
Sexually transmitted diseases
(chlamydia, gonorrhea, syphilis)
  No
Shiga-toxigenic E. coli 07/2015 Yes
Shigellosis 01/2012 No
Smallpox
Also available at cdc.gov
02/2004 No
Specimen submission form links
Syphilis
Taeniasis/Cysticercosis 02/2004 No
Tetanus 12/2003 No
Trichinosis - CDC form   No
Tuberculosis   No
Tularemia 06/2003 No
Typhoid Fever 04/2004 No
Typhoid - CDC form 03/2007 No
Typhoid Carrier Agreement 11/2003 No
Vibrio infection - CDC form
Use for all Vibrio infection (cholera, vulnificus, etc.)
07/2006 No
West Nile Virus 05/2008 No
Yersiniosis 08/2005 No

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