California Department of Public Health Forms

This Form is used for obtaining a veterinary certificate of quarantine in California for animals. It ensures that the animals have met the necessary health and safety requirements before entering or leaving the state.

This form is used for declaring laboratory testing in California.

This form is used for applying for a permit to import specified wild animals into California.

This Form is used for collecting contact information for individuals associated with tissue banks in California.

This Form is used for disclosing ownership and control interests in California.

This form is used for reporting cases of Guillain-Barre Syndrome (GBS) in California. It is a surveillance tool to track and monitor the occurrence of GBS cases in the state.

This form is used for reporting cases of invasive Haemophilus influenzae disease in California.

This document is used for reporting cases of Anthrax in humans in the state of California. It provides a standardized form for healthcare providers to report relevant information about the cases, including symptoms, demographics, and possible sources of exposure.

This document is used for investigating cases of cholera and other vibrio illnesses related to seafood in California.

This form is used for reporting cases of Hepatitis A in the state of California. It helps the health authorities track and monitor the spread of the disease for better public health response.

This form is used for transferring perinatal hepatitis B cases within the state of California as part of the Perinatal Hepatitis B Prevention Program.

This form is used for reporting perinatal hepatitis B cases in the state of California.

This form is used for reporting cases of brucellosis in the state of California. It is a required document for healthcare providers to notify the California Department of Public Health about diagnosed cases of brucellosis.

This form is used for reporting errors in post-exposure prophylaxis for HIV prevention in California. It helps track and prevent errors in the administration of medication for individuals at risk of contracting HIV.

This form is used for reporting cases of cysticercosis and taeniasis in California.

This Form is used for reporting cases of Ehrlichiosis/Anaplasmosis in California.

This form is used for reporting cases of Coccidioidomycosis, also known as Valley Fever, in California.

This form is used for reporting cases of Creutzfeldt-Jakob Disease in California.

This form is used for reporting cases of dengue fever in the state of California. It collects information about the individual, their symptoms and travel history to help track and prevent the spread of the disease.

This form is used for reporting cases of Chikungunya, a viral disease transmitted by mosquitoes, in the state of California. It helps track the spread of the disease and gather important data for public health monitoring.

This form is used for reporting Hantavirus infection cases in California. It is important for documenting and tracking these cases for public health purposes.

This form is used for reporting botulism cases in California. It is important for public health officials to collect this information to track and respond to outbreaks effectively.

This document is used for reporting data on gonorrhea cases in California. It is an important form for the California Gonorrhea Surveillance System.

This document is used for tracking and following up with individuals who have been in contact with someone diagnosed with meningococcal disease in California.

This Form is used for renewing the registration of a clinic laboratory in California. It is necessary to maintain compliance with state regulations.

This Form is used for reporting cases of Meningococcal Disease in California.

This form is used for reporting cases of mumps in the state of California.

This form is used for reporting malaria cases in California. It gathers information about the affected individual and helps track and monitor the spread of the disease.

This form is used for reporting cases of pertussis (whooping cough) in the state of California. It helps to track and monitor the spread of the disease and gather important information for public health purposes.

This form is used for reporting cases of Leptospirosis in California. It helps health authorities track and respond to the spread of the disease.

This form is used for reporting cases of Babesiosis in California. It contains important information about the disease and helps in tracking and monitoring its prevalence.

This form is used for reporting cases of Lyme Disease in California. It allows healthcare providers to provide essential information about the patient, their symptoms, and possible exposure to ticks.

This form is used for reporting poliovirus infection or poliomyelitis cases in California. It collects information on individuals affected by the disease to monitor and respond to outbreaks.

This form is used for reporting supplemental information for pertussis cases in California that are 4 months of age or younger.

This form is used for laboratory personnel in California to establish their qualification for working in a laboratory.