Reporting Forms
Use this form for reporting lapses of consciousness or control, Alzheimer's disease or other conditions which may impair the ability to operate a motor vehicle safely (pursuant to H&S 103900).
Use this form to report animal bites and fax to the local animal control listed on page 2 of this document.
OR You can use the Online Form
Please complete the ACRF, include a copy of patient's lab results, and send using certified/traceable mail to:
San Joaquin County Public Health Services
1601 East Hazelton Ave
Stockton, CA 95205
Attn: DCP
To report over the phone or for assistance completing the form, please call the HIV Surveillance Coordinator at (209) 468-9822. No fax available.
[17 CCR §2500(h)(i)]
- Report immediately by telephone (designated by a ♦ in regulations).
- Report immediately by telephone when two or more cases or suspected cases of foodborne disease from separate households are suspected to have the same source of illness (designated by a ● in regulations.)
- Report by electronic transmission (including FAX), telephone, or mail within one working day of identification (designated by a + in regulations).
All other diseases/conditions should be reported by electronic transmission including FAX), telephone, or mail within seven calendar days of identification.
§2500. Reporting to the Local Health Authority
- §2500(b) It shall be the duty of every health care provider, knowing of or in attendance on a case or suspected case of any of the diseases or conditions listed below, to report to the local health officer for the jurisdiction where the patient resides. Where no health care provider is in attendance, any individual having knowledge of a person who is suspected to be suffering from one of the diseases or conditions listed below may make such a report to the local health officer for the jurisdiction where the patient resides.
- §2500(c) The administrator of each health facility, clinic or other setting where more than one health care provider may know of a case, a suspected case or an outbreak of disease within the facility shall establish and be responsible for administrative procedures to assure that reports are made to the local health officer.
- §2500(a)(14) "Health care provider" means a physician and surgeon, a veterinarian, a podiatrist, a nurse practitioner, a physician assistant, a registered nurse, a nurse midwife, a school nurse, an infection control practitioner, a medical examiner, a coroner, or a dentist.