|COVID-19 Confidential Morbidity Report (CMR-110d) - Only use this form for reporting COVID-19|
|Canine Rabies Vaccination Exemption Certificate (10/12/2020)|
|Zika Virus Testing Guidelines and Request Form for Healthcare Providers|
|List of Reportable Diseases|
|Confidential Morbidity Report (CMR-110a) -Use this form for reporting all conditions except Tuberculosis and conditions reportable to DMV.|
|For after hours notification of immediately reportable diseases, call (209) 468-6000 and ask for public health.|
|Tuberculosis Confidential Morbidity Report (110b) - Only use this form for reporting Tuberculosis.|
|Lapse of Consciousness Confidential Morbidity Report (110c) - 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).|
| Animal Bite Report Updated!(3/19/2015)
Use this form to report animal bites and fax to the local animal control listed on page 2 of this document.
Please complete the HIV/AIDS Confidential Case Report and
San Joaquin County Public Health Services
For assistance and/or questions completing the form, call Rosa Castillo at 209.468.3475
|Pesticide Illness Report|
The primary objectives of disease surveillance are:
- To determine the extent of morbidity within the community.
- To evaluate risks of transmission.
- To intervene rapidly when appropriate.
For surveillance to be effective, the reporting of communicable diseases must be timely. Delay or failure to report communicable diseases has contributed to serious consequences in the past. Reports by health care providers form the basis for monitoring communicable diseases. The information provided is crucial for interrupting transmission, recognizing and controlling outbreaks, following trends, and informing the medical community about local occurrence of communicable diseases. Failure to report can result in increased diseases in the community, increased costs for diagnosis and treatment, additional time lost from work or school, prolonged hospitalization, and possibly death.
Who Should Report:
State Law (California Code of Regulations, Title 17, Health and Safety Code, Section 2500; see full text below) requires health care providers to report certain diseases and conditions of public health importance to the local health department. Many physicians are not aware of their responsibility to report these diseases and conditions. Laboratory reporting of a particular disease does not relieve the physician of this responsibility. Patient consent is NOT needed to report cases or suspect cases, or to supply additional information requested by Public Health.
What To Report:
The list of diseases and conditions required to be reported to the local health department is available in the “Reporting Forms" section above. Most of these are communicable diseases as required in Title 17, California Code of Regulations, §2500.
The following is the list of Reportable Noncommunicable Diseases and Conditions §2800–2812 and §2593(B):
- 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)
How To Report:
Reports should be submitted by mail, telephone, or fax depending on the disease category. A standard form, known as the Confidential Morbidity Report (CMR) is available in the "Reporting Forms" section above for reporting most diseases and conditions. A separate CMR report form should be completed for each disease. Please complete all sections of the CMR.
The HIV/AIDS Case Reporting Form is also available in the "Reporting Forms" section above; this form may only be submitted by mail. The Public Health Services HIV/AIDS Surveillance Coordinator is available to assist in report completion. The confidentiality of patient information is always protected.
Urgency of Reporting Requirements [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.)|
|FAX||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|
Where To Report
For all diseases except HIV/AIDS and
For Sexually Transmitted Diseases:
For HIV/AIDS Reports:
Title 17, California Code of Regulations (CCR), §2500
Reportable Diseases and Conditions*
§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.