California Department of Public Health Forms

This form is used for reporting cases of Psittacosis in California. It is required to document information about the infected person, including their symptoms and potential sources of exposure.

This form is used for reporting cases of human rabies in the state of California. It includes information about the patient, their medical history, and potential sources of exposure to the rabies virus.

This form is used for reporting cases of plague (human) in the state of California.

This form is used for reporting cases of rubella (German measles) in California. It gathers information about the individual, their symptoms, and any possible sources of exposure.

This form is used for requesting a search of syphilis records from out-of-state healthcare providers in California.

This form is used for reporting Q fever cases in California. It helps health authorities track and monitor this infectious disease for public safety.

This form is used for reporting cases of relapsing fever in California. It helps track and study the spread of the disease.

This Form is used for reporting cases of Spotted Fever Rickettsioses in California.

This form is used for investigating and reporting cases of congenital syphilis in California.

This form is used for reporting severe cases of Community-Associated Staphylococcus Aureus Infection in California. It helps in tracking and monitoring the spread of this infection throughout the community.

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

This Form is used for the semiannual update of the Typhoid Carrier Register in California.

This document is a form used for reporting cases of Toxic Shock Syndrome (Non-streptococcal) in California.

This form is used for reporting cases of trichinosis in California. It helps track and monitor the occurrence of this disease for public health purposes.

This form is used for reporting supplemental investigations of West Nile Virus (WNV) infection cases in California.

This form is used for reporting cases of West Nile Virus (WNV) infection in California. It provides a standardized way to collect and track information about individuals diagnosed with WNV.

This form is used for reporting cases of typhoid carriers in California.

This form is used for reporting cases of tularemia in California.

This Form is used for reporting cases of typhoid and paratyphoid fever in California.

This form is used for individuals in California who are carriers of typhoid and need to enter into an agreement with the state health department.

This form is used for reporting cases of hospitalized patients with varicella (Chicken Pox) in California.

This Form is used for recording interviews related to syphilis in California.

This form is used for reporting cases of viral hemorrhagic fever in animals in California.

This form is used for reporting cases of viral hemorrhagic fever in California.

This form is used for reporting cases of yellow fever in California. Submitting this form helps track and monitor the spread of yellow fever in the state.

This form is used for reporting cases of Shiga toxin-producing Escherichia coli (STEC) and/or Hemolytic Uremic Syndrome (HUS) in the state of California.

This form is used for reporting other outbreaks or diseases of unusual occurrence in California.

This form is used for conducting an interview in California with emergency department staff or flight personnel who have come into contact with a patient suspected or confirmed to have Ebola. It helps to gather important information for monitoring and controlling the spread of the disease.

This form is used for conducting interviews with healthcare workers who have been in contact with Ebola patients in California. It helps gather information about potential exposure and monitor their health.

This form is used for health department follow-up in the state of California.

This form is used for conducting interviews with household or community contacts of Ebola patients in California. It gathers important information to help prevent the spread of the disease.

This form is used for reporting cases of Rh Hemolytic Disease of the Newborn in California. It is a confidential case report that helps track and monitor this condition to ensure proper care for affected infants.

This Form is used for reporting foodborne disease outbreaks in California. It allows individuals and organizations to provide important information about the outbreak, such as the number of cases, symptoms, and potential food sources. This document helps the California Department of Public Health identify and investigate instances of foodborne illnesses to prevent further outbreaks.

This form is used for parents in California who want to request the destruction of their newborn's blood specimen card.