U.S. Department of Health and Human Services - Centers for Disease Control and Prevention Forms

This document is used for tracking and documenting information related to suspected cases of polio.

This document is used for tracking and reporting cases of pertussis, a contagious respiratory infection commonly known as whooping cough. It helps healthcare providers gather information necessary for surveillance and prevention efforts.

This document is for collecting data related to mumps cases as part of surveillance efforts.

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.

This Form is used for tracking cases of Streptococcus Pneumoniae.

This form is used for reporting and documenting cases of human infection with the 2019 Novel Coronavirus.

Este tipo de formulario se utiliza como parte de las medidas de prevención del CDC (Centros para el Control y la Prevención de Enfermedades) para combatir la Listeria, una bacteria que puede causar enfermedades transmitidas por los alimentos.

This form is used for reporting cases of swine influenza.

This form is used for assessing the capacity of ports to handle the impacts of Covid-19. It is in French.

This form is used for conducting a rapid assessment of the capacity of a point of entry (POE) to handle Covid-19 cases. The form is in Russian.

This form is used for assessing the capacity of ports during the Covid-19 pandemic. It is specifically designed for Arabic speakers.

This document provides a pocket-sized card with information on the outbreak of Hepatitis A, including its symptoms, transmission, and prevention methods.

This type of document is a pocket card that provides information and reminders about getting vaccinated for Hepatitis A.

This form is used for tracking the medication regimen for latent tuberculosis (TB) infection. It covers a 3-month period and includes daily doses of Isoniazid and Rifampin.

This form is used for transferring control of infection between different healthcare facilities.

This form is used for reporting cases of Multisystem Inflammatory Syndrome associated with Covid-19.

This document is used for checking and recording daily activities or tasks.

This document provides basic information about formaldehyde and its potential health effects. It covers its common uses, exposure sources, and how to reduce exposure.

This document provides important information about the relationship between marijuana use and driving. It highlights the potential risks and consequences of driving under the influence of marijuana, as well as tips to stay safe on the road.

This document provides important information about the effects of marijuana use on driving and what individuals need to know before getting behind the wheel.

This document provides information about diabetes, a chronic medical condition that affects blood sugar levels. It includes causes, symptoms, and treatment options for managing diabetes.

This document explores the connection between mental health and chronic diseases. It discusses how mental health issues can impact the management and treatment of chronic conditions, as well as the importance of addressing both mental and physical well-being for overall health.

This form is used for completing a pre-vaccination checklist for individuals receiving the Covid-19 vaccine.

This form is used for creating a checklist of essential items needed in a pet disaster kit. It includes items such as food, water, medications, and identification tags.

This Form is used for implementing enhanced barrier precautions in skilled nursing facilities and nursing homes. It helps to improve the safety measures against infections.

This document provides stature-for-age and weight-for-age charts for girls between the ages of 2 to 20 years. It helps track the growth and development of girls and can be used by parents, caregivers, and healthcare professionals.

This document provides growth charts for girls from birth to 36 months. It helps track a child's growth and development in relation to other children of the same age and gender.

This document provides growth charts specifically designed for girls aged 2 to 20 years. It includes percentiles for both stature-for-age and weight-for-age, which can be used to track a girl's growth and compare it to the average.

This type of document provides growth charts for boys from birth to 24 months. It helps track and monitor their growth and development over time.

This document is a child's growth chart that is available in both English and Spanish. It helps track a child's physical development over time.

This form is used for documenting the rabies vaccination and microchip information for a pet.

This document provides a checklist of common signs and symptoms to help identify if someone has a concussion.

This document is a checklist created by the American Academy of Pediatrics for tracking the developmental milestones of a 1-year-old child. It is available in both English and Spanish.