Case Report Form Templates

This Form is used for reporting cases of Arbovirus (mosquito-borne viruses) in New Mexico.

This document is a confidential HIV case report for the state of New Mexico. It contains important information about individuals with HIV in the state.

This Form is used for reporting cases of the novel coronavirus (COVID-19) in the state of Illinois.

This Form is used for reporting cases of pediatric deaths associated with influenza. It helps track and analyze the data to understand the impact of influenza on children.

This form is used for reporting pediatric HIV/AIDS cases in Michigan. It is a confidential case report form.

This form is used for reporting cases of Multisystem Inflammatory Syndrome associated with Covid-19. It provides instructions on how to fill out the necessary information for reporting and documenting these cases.

This Form is used for reporting confidential information on influenza-associated hospitalizations in Ohio.

This document is used for reporting confidential cases of sexually transmitted diseases in Adams County, Washington.

This Form is used for reporting confidential sexually transmitted disease cases in Asotin County, Washington.

This Form is used for reporting confidential sexually transmitted disease cases in Ferry County/Northeast Tri County Health District, Washington.

This document is used for reporting confidential information about sexually transmitted disease cases in Columbia County, Washington.

This document is used for reporting cases of sexually transmitted diseases in Cowlitz County, Washington.

This form is used for reporting confidential sexually transmitted disease cases in Garfield County, Washington.

This form is used for reporting confidential cases of sexually transmitted diseases in Grant County, Washington.

This form is used for reporting confidential cases of sexually transmitted diseases in the Chelan-Douglas Health District, Washington. It ensures the privacy and anonymity of individuals affected by these diseases.

This form is used for reporting confidential cases of sexually transmitted diseases in Clark County, Washington.

This form is used for reporting confidential information regarding sexually transmitted diseases in Mason County, Washington.

This form is used for confidentially reporting cases of sexually transmitted diseases in Kitsap County, Washington.

This document is used for reporting confidential cases of sexually transmitted diseases in Klickitat County, Washington. It helps in tracking and controlling the spread of such diseases.

This form is used for reporting confidential cases of sexually transmitted diseases in Kittitas County, Washington.

This Form is used for reporting confidential sexually transmitted disease cases in Lewis County, Washington.

This form is used for reporting confidential information about sexually transmitted disease cases in San Juan County, Washington. It helps to track and monitor the spread of STDs and ensure appropriate public health interventions.

This Form is used for reporting confidential cases of sexually transmitted diseases in Stevens County, Washington.

This document is used for reporting confidential cases of sexually transmitted diseases in Whatcom County, Washington.

This Form is used for reporting confidential sexually transmitted disease cases in Skamania County, Washington.

This form is used for reporting confidential cases of sexually transmitted diseases in Thurston County, Washington. It ensures that proper information is collected and maintained to help prevent the spread of STDs.

This document is used for reporting confidential cases of sexually transmitted diseases in Yakima County, Washington.

This form is used for reporting confidential sexually transmitted disease cases in Whitman County, Washington.

This Form is used for reporting confidential cases of sexually transmitted diseases in Skagit County, Washington. It is important for tracking and monitoring public health.

This Form is used for reporting confidential sexually transmitted disease cases in Wahkiakum County, Washington.

This form is used for reporting confidential cases of sexually transmitted diseases in the Benton-Franklin Health District, Washington. It helps to gather important information about these cases for monitoring and public health purposes.

This document is used for reporting confidential cases of sexually transmitted diseases in Island County, Washington.

This document provides a report on a tuberculosis case in Washington, D.C. It includes relevant information about the case and its impact.

This form is used for reporting cases of tickborne rickettsial disease in Wisconsin.

This Form is used for reporting cases of Tickborne Rickettsial Disease.

This form is used for reporting cases of Babesiosis, a tick-borne disease, to the Centers for Disease Control and Prevention (CDC). It helps track and monitor the incidence of Babesiosis in the United States.

This Form is used for reporting cases of Coccidioidomycosis (Valley Fever) in Ohio. It is part of an enhanced surveillance program to track and monitor the spread of this fungal infection.

This form is used for reporting cases of Brucellosis, a bacterial infection that can be transmitted from animals to humans. It collects important information about the infected individual and helps healthcare professionals track and monitor the disease.

This form is used for reporting cases of Q Fever, a bacterial infection that can cause flu-like symptoms and is transmitted to humans from animals.

This form is used for reporting cases of leptospirosis, a bacterial infection spread through contact with contaminated water.