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    Infectious Disease Control Unit
    Mail Code: 1960
    PO BOX 149347 - Austin, TX 78714-9347
    1100 West 49th Street, Suite T801
    Austin, TX 78714

    Phone: 512 776 7676
    Fax: (512) 776-7616


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Investigation Forms

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INVESTIGATION

IDCU Home       Investigation Guidance

Alphabetical Listing of Investigation Forms   

A-C   E-I   L-Q   R-W

A-D

  • Amebic Meningitis/Encephalitis Case Report Form (Free-Living Ameba Case Report Form, PDF, 163 KB, January 2012)
  • Arboviral Case Investigation Form (PDFPDF, 105 KB, January 2015)
  • Anthrax Case Investigation Form (PDFPDF, 18 KB, August 2004)
  • Babesiosis Case Report Form (PDFPDF, 658 KB, June 2013)
  • Botulism Forms
    Foodborne Investigation Form (PDFPDF, 18 KB, May 16, 2007)  
    Infant Investigation Form (PDFPDF, 20 KB, May 16, 2007) 
  • Brucellosis Case Investigation Form (PDFPDF, 61.2 KB, January 2015)
  • Chagas’ Disease Case Investigation Form (PDFPDF, 47 KB, June 2013)
  • Cholera Surveillance Form, August 2008 revision (PDFPDF, 140 KB, August 2007)
  • Communicable Disease Reporting Forms
    EPI-1 (PDFPDF, 78.3 KB, August 2015)
    EPI-2 (PDFPDF, 66.6 KB, August 2015)
  • Contaminated Sharps Injury Reporting Forms
  • Coronavirus, Novel; Middle East Respiratory Syndrome (MERS) – Patient Under Investigation (PUI) Short Form (PDF, 168 KB, July 2014)
  • Cyclosporiasis Investigation Form (PDF, 147 KB, July 2014)
  • Dengue Case Investigation Form (PDFPDF, 42 KB, January 2015)

 


E-I


L-Q

  • Legionellosis Investigation Report Form , April 2002 revision (PDFPDF, 32 KB, September, 2011) 
  • Leishmaniasis Case Investigation Form (PDFPDF, 51 KB, June 2013) 
  • Listeria Case (with supplemental medical history form) Form, CDC (PDFPDF, 197 KB) 
  • Lyme Case Investigation Form (PDFPDF, 74 KB, October 2013)
  • Malaria Investigation Form, CDC (PDFPDF, 118 KB)
  • Measles (Rash-Fever) Investigation Form (PDFPDF, November 2012)
  • Meningococcal (Neisseria Meningitidis) Investigation Form (PDFPDF, 194 KB, May 2014) 
  • Mosquito Borne Illness Case Investigation Form (PDFPDF, 73 KB, January 2012)
    Used for Dengue, California Encephalitis, Eastern/Venezuelan/Western Equine Encephalitis, St. Louis Encephalitis, West Nile Fever, and Yellow Fever
  • Multi-drug Resistant Organism Investigation FormForm Instructions (PDFPDF, May 2015)
  • Mumps Investigation Form (PDFPDF, 34.3KB, March 2013)
  • Pertussis Investigation Form (WORD, December, 2013)
  • Pertussis Death Investigation Form, CDC (PDFPDF
  • Plague Case Investigation Form (PDFPDF, 67.0 KB, November 2004)
  • Q Fever Investigation Form (PDFPDF, 62.7 KB, August 2004)

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R-W

  • Rash-Fever Illness Case Track Record (PDF, November 2012)
  • Respiratory Disease Contact Tracking Form (PDFPDF, 30 KB September 2011)
  • Respiratory Disease Outbreak Summary Form (PDFPDF, September 2011)
  • Rickettsial Disease Case Investigation Form  (PDFPDF, 16 KB, May 2006)
    Used for Anaplasmosis, Ehrlichiosis, Typhus, and Spotted Fever Group Rickettsiosis
  • Rubella (Rash-Fever) Investigation Form (PDFPDF, 98.4 KB, May 2008)
  • Smallpox Investigation Forms, CDC 
    Evaluating Patients for Smallpox (PDFPDF, 182 KB, March 4, 2002)
    Post Event Surveillance Form (PDFPDF, 147 KB, June 2003)
  • Streptococcal Investigation Form (PDFPDF, 35 KB, July, 2015) 
  • Taenia Tapeworm Investigation Form (PDFPDF link, 53.4 KB, April 2007)
  • Tetanus Investigation Form (PDFPDF, 150 KB, May 2014)
  • Tick-borne Relapsing Fever Case Investigation Form (PDFPDF, 54.4 KB, August 2004)
  • Trichinosis Case Report Form (PDFPDF, 30 KB, June 2013)
  • Tuberculosis Forms (including Report of Case and Patient Services, November 2003)
  • Tularemia Case Investigation Form (PDFPDF, 62.1 KB, August 2004)
  • Typhoid Fever Surveillance Report, CDC (PDFPDF, 86 KB, April 2009)
  • Varicella (Chickenpox)  Reporting Form  (PDFPDF, June 2012)
  • Varicella (Chickenpox)  Outbreak Form  (PDF PDF, 101 KB, 2015) 
  • Varicella Death Investigation Form, CDC  (PDFPDF, 91 KB, May 9, 2005)
  • Vibriosis Surveillance Form, August 2008 revision   (PDFPDF, 140 KB, August 2008)
  • Viral Gastroenteritis Outbreak Reporting Form (PDFPDF, 655 KB, February 2004)
  • Viral Hepatitis Case Tracking Form (PDF, March 2013)
  • VRSA/VISA Case Report Form (PDFPDF, 65 KB, January 3, 2011)
  • Yersiniosis Case Investigation Form, 1998 revision (PDFPDF, 13 KB, May 16, 2007)
  • Waterborne Disease Outbreak Reporting Form (PDFPDF, 87 KB)
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Last updated August 31, 2015
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