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

Resources

For Local Public Health Authorities

For Providers and Laboratories

Investigative Guidelines

Outbreak Investigation (pdf)

Reporting Disease: What and When to Report

Disease Reporting Posters

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	02/2018	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
Cryptosporidiosis	07/2018	Yes
Cyclosporiasis	12/2004	No
Diphtheria	09/2018	No
Ehrlichiosis - CDC form		No
Escherichia coli O157	02/2019	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	11/2016	Yes
Hepatitis B acute	01/2015	Yes
Hepatitis B chronic	03/2010	No
Hepatitis B Perinatal Case Management Form	06/2018	No
Hepatitis C acute	01/2015	Yes
Hepatitis C chronic	01/2015	Yes
Hepatitis E	07/2011	No
HIV Infection		No
Influenza-related Hospitalizations	03/2019	No
Legionellosis	11/2003	No
Listeriosis	01/2004	No
CDC Listeriosis Supplement - English Spanish	04/2016	No
Lyme Disease	6/2003	No
Malaria	1/2017	Yes
Measles	09/2018	Yes
Meningococcal Disease	03/2007	No
Mumps	10/2018	Yes
Nontuberculous Mycobacterium (NTM) - Extrapulmonary	03/2018	Yes
Novel Influenza A, such as H5N1 or H7N9	11/2016	No
Pertussis	09/2018	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	03/2018	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 Oregon State Public Health Lab: Specimen submission forms page West Nile virus specimen submission
Syphilis Congenital Syphilis Form Visual Case Analysis Form Visual Case Analysis Instructions
Taeniasis/Cysticercosis	02/2004	No
Tetanus	12/2003	No
Trichinosis - CDC form		No
Tuberculosis TB Case Report and Data Entry Manual (pdf)	12/2018	No
Tularemia Oregon form CDC form	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

For Outbreaks

Get summaries, worksheets and case logs

Form	Last Updated
Facility Respiratory Outbreak Investigation Worksheet (xls)	09/2009
Gastroenteritis (GI) case log	10/2007
Gastroenteritis Foodborne Transmission Outbreak Summary	03/2011
Gastroenteritis Non-foodborne Transmission Outbreak Summary	03/2011
Gastroenteritis Indeterminate Transmission Outbreak Summary	03/2011
Non-GI Outbreak Summary	10/2004
Varicella case log	04/2014
Waterborne Outbreak Summary - CDC form	12/1996