Investigation Forms

Investigation (Investigation Forms, Notifiable Conditions, Electronic Reporting, Reporting Forms, Laboratory Reporting)

Alphabetical Listing of Investigation Forms

A-C   E-I   L-Q   R-W

A-C

• Anthrax Case Investigation Form (PDF, 18KB, August 2004)
  
• Botulism Forms
  Foodborne Investigation Form (PDF, 18KB, May 16, 2007)  
  Infant Investigation Form (PDF, 20KB, May 16, 2007) 
  
• Brucellosis Case Investigation Form (PDF, 61.2KB, August 2004)
  
• Chagas’ Disease Case Investigation Form (PDF, 47KB, April 2013)


• Cholera Surveillance Form, August 2008 revision (PDF, 140KB, August 2007)
  
• Communicable Disease Reporting Forms
  EPI-1 (PDF, 78.3KB, October 2012)
  EPI-2 (PDF, 66.6KB, October 2012)
• Contaminated Sharps Injury Reporting Forms
  
• Cruetzfeld Jakob Disease (PDF, 78.3KB, July 16, 2008) 

E-I

• Escherichia coli O157:H7 and Hemolytic Uremic Syndrome Investigation Form, 1998  (PDF, 20KB, May 16, 2007) 
  
• Escherichia coli O157:H7 Food History Listing Form (PDF, 62KB)
  
• Foodborne Outbreak Investigation Form (PDF, 146KB, March 2008)
  
• Haemophilus influenzae Investigation Form (PDF)
  
• Hansen's Disease Investigation Forms
  
• Hantavirus Pulmonary Syndrome Form, CDC (PDF, 187KB, August 2002)
• Hepatitis A Investigation Form (Viral Hepatitis Case Tracking Form)  (PDF, March 2013)
• Hepatitis B Investigation Form (Viral Hepatitis Case Tracking Form)  (PDF, March 2013)
• Hepatitis C Investigation Form (Viral Hepatitis Case Tracking Form)  (PDF, March 2013)
  
• Hepatitis B, Perinatal
  
• Hypothesis Generating Questionnaire for Gastroenteritis Complaints (PDF, 14KB, April 14, 1999)
  
• Influenza-Associated Pediatric Death Investigation Form (PDF, 120KB, September, 2011)
  
• Influenza, General Investigation Form (PDF, 35KB, September, 2011)
  
• Influenza, Supplemental Investigation Questions (PDF, 42KB, September, 2011)
  
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L-Q

• Legionellosis Investigation Report Form , April 2002 revision (PDF, 32KB, September, 2011) 
  
• Leishmaniasis Case Investigation Form (PDF, 113KB, April 2007) 
  
• Listeria Case (with supplemental medical history form) Form, CDC (PDF, 197KB) 
  
• Lyme Case Investigation Form (PDF, 74KB, August 2011)
  
• Malaria Investigation Form, CDC (PDF, 118KB)
  
• Measles (Rash-Fever) Investigation Form (PDF, November 2012)


• Meningococcal (Neisseria Meningitidis) Investigation Form (PDF, 123KB, September, 2011) 
  
• Mosquito Borne Illness Case Investigation Form (PDF, 73KB, January 2012)
  Used for Dengue, California Encephalitis, Eastern/Venezuelan/Western Equine Encephalitis, St. Louis Encephalitis, West Nile Fever, and Yellow Fever
  
• Mumps Investigation Form (PDF, 34.3KB, March 2013)
  
• Pertussis Investigation Form (PDF, March 2012)
  
• Pertussis Death Investigation Form, CDC (PDF) 
• Plague Case Investigation Form (PDF, 67.0KB, November 2004)
  
• Q Fever Investigation Form (PDF, 62.7KB, August 2004)
  
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R-W

• Rash-Fever Illness Case Track Record (PDF, November 2012)
• Respiratory Disease Outbreak Summary Form (PDF, September 2011)
• Rickettsial Disease Case Investigation Form  (PDF, 16KB, May 2006)
  Used for Anaplasmosis, Ehrlichiosis, Typhus, and Spotted Fever Group Rickettsiosis
  
• Rubella (Rash-Fever) Investigation Form (PDF, 98.4KB, May 2008)
  
• Smallpox Investigation Forms, CDC 
  Evaluating Patients for Smallpox (PDF, 182KB, March 4, 2002)
  Post Event Surveillance Form (PDF, 147KB, June 2003)
  
• Streptococcal Investigation Form (PDF, 35KB, August, 2012 ) 
  
• Taenia Tapeworm Investigation Form (PDF link, 53.4Kb, April 2007)
  
• Tetanus Investigation Form (PDF, November 2012)
  
• Tick-borne Relapsing Fever Case Investigation Form (PDF, 54.4KB, August 2004)
  
• Tuberculosis Forms (including Report of Case and Patient Services, November 2003)
• Tularemia Case Investigation Form (PDF, 62.1KB, August 2004)
  
• Typhoid Fever Surveillance Report, CDC (PDF, 86KB, April 2009)
  
• Varicella (Chickenpox)  Reporting Form  (PDF, June 2012) 
  
• Varicella Death Investigation Form, CDC  (PDF, 91KB, May 9, 2005)
  
• Vibriosis Surveillance Form, August 2008 revision   (PDF, 140KB, August 200


• Viral Gastroenteritis Outbreak Reporting Form (PDF, 655KB, February 2004)
• Viral Hepatitis Case Tracking Form (PDF, March 2013)
  
• VRSA/VISA Case Report Form (PDF, 65KB, January 3, 2011)
  
• Yersiniosis Case Investigation Form, 1998 revision (PDF, 13KB, May 16, 2007)
  
• Waterborne Disease Outbreak Reporting Form (PDF, 87KB)
  
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