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Disease Reporting Information and Forms

Download printable PDF of Reportable Diseases grid

REPORT IMMEDIATELY BY PHONE During Business hours: (831) 454-4114 After hours: (831) 471-1170
Anthrax, human or animal Botulism (Infant, Foodborne, Wound, Other) Brucellosis, human Cholera Ciguatera Fish Poisoning Diphtheria Domoic Acid Poisoning (Amnesic Shellfish Poisoning) Flavivirus infection of undermined species	Foodborne Disease (when two or more cases or suspected cases of foodborne disease from separate households are suspected to have the same source of illness) Hemolytic Uremic Syndrome Influenza due to novel strains (human) Measles (Rubeola) Meningococcal Infections Middle East Respiratory Syndrome (MERS) Novel Virus with Pandemic Potential	Paralytic Shellfish Poisoning Plague, Human or Animal Rabies, Human or Animal Scombroid Fish Poisoning Shiga Toxin (detected in feces) Smallpox (Variola) Tularemia, human Viral Hemorrhagic Fevers, human or animal (Crimean-Congo, Ebola, Lassa, and Marburg viruses) Occurrence of any unusual disease Outbreak of any disease (including diseases not listed in §2500)

REPORT WITHIN ONE WORKING DAY PHONE: (831) 454-4114 FAX: (831) 454-5049
Babesiosis Campylobacteriosis Carbapenem-Resistant Enterobacteriaceae (CRE) Chickenpox (Varicella) (outbreaks, hospitalizations, and deaths) Chikungunya Virus Infection Cryptosporidiosis Dengue Virus Infection Encephalitis, specify etiology (Viral, Bacterial, Fungal, Parasitic) Escherichia coli: Shiga toxin-producing (STEC), including E. coli 0157:H7 Foodborne Disease	Haemophilus influenzae, invasive disease (only in persons less than 5 years of age) Hantavirus Infections Hepatitis A, acute infection Listeriosis Malaria Meningitis, specify etiology (Viral, Bacterial, Fungal, Parasitic) Paratyphoid Fever Pertussis (whooping cough) Poliovirus Infection Psittacosis Q Fever Relapsing Fever	Salmonellosis (other than Typhoid Fever) Shigellosis Syphilis (all stages, including congenital) Trichinosis Tuberculosis (TB) Typhoid Fever, Cases and Carriers Vibrio Infections West Nile Virus Infection Yellow Fever Yersiniosis Zika Virus Infection

REPORT BY PHONE, FAX OR MAIL WITHIN 7 CALENDAR DAYS PHONE: (831) 454-4114 FAX: (831) 454-5049 MAIL: Attn: Communicable Disease 1060 Emeline Ave, Santa Cruz, CA 95060
Anaplasmosis Brucellosis, animal (except infections due to Brucella canis) Chancroid Coccidioidomycosis Creutzfeldt-Jacob Disease (CJD) and other Transmissible spongiform Cyclosporiasis Cysticercosis or Taeniasis Ehrlichiosis Giardiasis Gonococcal Infections	Hepatitis B (specify acute, chronic, or perinatal) Hepatitis C (specify acute, chronic, or perinatal) Hepatitis D (Delta) (specify acute case or chronic) Hepatitis E, acute infection Influenza, deaths in laboratory-confirmed cases for persons less than 18 years old Legionelllosis Leprosy (Hansen’s Disease) Leptospirosis Lyme Disease	Mumps Respiratory Syncytial Virus-associated deaths in laboratory-confirmed cases less than five years of age Rickettsial Diseases (non-Rocky Mountain Spotted Fever), including Typhus and Typhus-like illnesses Rocky Mountain Spotted Fever Rubella (German Measles) Rubella Syndrome, congenital Tetanus Toxoplasmosis Tularemia, animal

REPORT BY PHONE, FAX OR TRACEABLE MAIL WITHIN 7 CALENDAR DAYS
PHONE: (831) 454-4838
FAX: (831) 454-5049

Human Immunodeficiency Virus (HIV), any stage
HIV infection, progression to stage 3 (AIDS)

Case reports or laboratory reports must be placed in a sealed envelope and sent via
traceable mail (USPS Certified, FedEx, or UPS) marked "Confidential", with attention to:

Santa Cruz County Health Services Agency
ATTN: HIV Surveillance Coordinator
1060 Emeline Ave, Santa Cruz, CA 95060

REPORTABLE NONCOMMUNICABLE DISEASES AND CONDITIONS §2800–2812 and §2593 (b) PHONE: (831) 454 - 4114 FAX: (831) 454 - 5049 MAIL: Attn: Communicable Disease 1060 Emeline Ave, Santa Cruz, CA 95060
Disorders Characterized by Lapses of Consciousness (§2800-2812) Pesticide-related illness or injury (known or suspected cases) Cancer, including benign and borderline brain tumors (except (1) basal and squamous skin cancer unless occurring on genitalia, and (2) carcinoma in-situ and CIN III of the Cervix) (§2593) *

*	This form is designed for health care providers to report those diseases mandated by Title 17, California Code of Regulations (CCR). Failure to report is a misdemeanor (Health & Safety Code §120295) and is a citable offense under the Medical Board of California Citation and Fine Program (Title 16, CCR, §1364.10 and 1364.11).
**	Failure to report is a citable offense and subject to civil penalty ($250) (Health and Safety Code §105200).
***	The Confidential Physician Cancer Reporting Form may also be used. See Physician Reporting Requirements for Cancer Reporting in CA at: www.ccrcal.org.

Note: Unusual diseases can include serious, unexpected, or unexplained acute illnesses, particularly those involving atypical host characteristics; syndromes of uncertain cause that a healthcare provider suspects may be due to a transmissible infectious agent or microbial toxin; or a single case of a communicable disease that has been long absent from the population or previously unrecognized. They may also include rare or emerging diseases, unexpected increases in illness occurring out of season, or cases showing an unusual age distribution. Clusters of similar illnesses occurring during the same time period—especially among individuals linked by a shared event or location—may also be considered unusual. In addition, events such as epidemics, poisonings, fires, major accidents, deaths from unnatural causes, or any other occurrence that threatens public health, safety, or welfare fall into this category. This list is not exhaustive; when in doubt, it is important to report.

Confidential Morbidity Report (CMR)

For STD's or TB, use the forms under those categories below. In the absence of a condition-specific form, please use the General Confidential Morbidity Report form.

Outbreaks and Foodborne Illness

Sexually Transmitted Diseases (STD)

How to Report STDs Using the CMR Form
STD CMR Form: PDF Version or Microsoft WORD
CA. STD Treatment Guidelines, 2021
CA. STD Screening Recommendations, 2021

Tuberculosis (TB)

Download printable PDF of Santa Cruz County HIV/AIDS Reporting Requirements

Under California law (California Code of Regulations, Title 17, Sections 2641.5–2643.2), medical providers, laboratories, hospitals, and other entities are required to report suspected or confirmed cases of HIV or AIDS to the local health department within 7 calendar days. Like many other reportable communicable diseases, HIV/AIDS reporting involves a dual process in which both healthcare providers and laboratories must submit separate reports.

Reporting Procedures
What cases must be reported?	Cases must be reported for all individuals who test positive for HIV, as well as those whose clinical condition or test results meet the diagnostic criteria for AIDS. For the most current HIV/AIDS case definitions and updates, refer to the CDC’s 2014 publication Morbidity and Mortality Weekly Report (MMWR).
Who reports?	Healthcare providers and laboratories are required to report all patients with test results indicative of HIV infection to the local health department within 7 calendar days. In Santa Cruz County, HIV case reports are managed by the HIV Surveillance Coordinator within the Communicable Disease Unit. When a laboratory identifies a test result suggestive of HIV infection, it submits limited patient information to the HIV Surveillance Coordinator and forwards the results to the ordering provider. The provider is then responsible for completing and submitting a Case Report Form to the HIV Surveillance Coordinator
How to report Do not submit any information via email.	For detailed information on California’s laboratory-specific HIV reporting regulations, click here. Healthcare providers can submit required HIV case reporting information using one of the following methods: Option 1: Report by Fax or Mail A) For patients aged 13 years or older at the time of diagnosis: Download and complete the Adult HIV/AIDS Confidential Case Report. Instructions for completing the form. B) For patients under 13 years old at the time of diagnosis: Download and complete the Pediatric HIV/AIDS Confidential Case Report. C) Submit case reports via fax: (831) 454-5049 D) Or mail case reports using double envelopes to: Santa Cruz County Health Services Agency ATTN: HIV Surveillance Coordinator 1060 Emeline Ave, Santa Cruz, CA 95060 Option 2: Report by Phone Call (831) 454-4838 to complete the report over the phone. Our team will assist physicians or designated staff in collecting the necessary information and completing the form.
Why prompt reporting is critical	To ensure that newly diagnosed individuals are promptly linked to care, that those previously diagnosed receive ongoing support, and to effectively monitor epidemic trends and secure adequate funding for local HIV treatment and prevention efforts.
Connect with CARe	Our HIV Partner Services Program provides tailored interventions to help prevent further transmission. With several disclosure options available, our trained staff support individuals in notifying their partners about potential exposure to HIV and other STDs—while also connecting them to testing, treatment, and ongoing medical care. To refer your patient to our Community Advocacy Resource/Education (CARe) Team or to learn more about available services, please click here.

For more information on HIV / AIDS reporting, visit the Office of AIDS – HIV Reporting Laws

Review CDPH HIV Reporting & CDC Algorithm Update (2015)

Additional Information:

Tests indicative of HIV infection include:

AIDS defining conditions

Confirmed positive HIV antibody test (for more information click here)
Any viral load test
Positive P24 antigen test
Positive viral isolation test
Positive Nucleic Acid Testing (NAT)
CD4+T-cell test (clinical laboratories may withhold report if they can demonstrate that the CD4+T-cell test is unrelated to a diagnosed case of HIV infection)