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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) 454-4730
FAX: (831) 454-5220

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.

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)