Case report forms for selected infectious diseases may be found below. If you do not see the relevant form, or if you have questions about how to report an infectious disease, please call (617) 983-6801.
- This page, Infectious disease case report forms , is offered by
- Bureau of Infectious Disease and Laboratory Sciences
- Department of Public Health
Infectious disease case report forms
Table of Contents
E-cigarette/Vaping-Associated Lung Injury (EVALI)
Chancroid/LGV/Granuloma Inguinale/PID (Agent Unknown)
Report COVID-19 infections resulting in hospitalization or death in fully vaccinated individuals ONLY. Fully vaccinated means at least 14 days after a final dose. Do not use for other COVID-19 case reporting.
Instructions for reporting COVID-19 infections resulting in hospitalization or death in fully vaccinated individuals
Use this form to report any known or suspected clusters of gastrointestinal illness in Long Term Care Facilities.
Use this form to report pregnant women with laboratory evidence of hepatitis B infection.
Use this form to report infants born to hepatitis B infected women. Please include HBIG and hepatitis B vaccine birth dose information.
Use this form to report any known or suspected clusters of influenza or other respiratory illness in Long Term Care Facilities.
MDPH no longer requires providers report rapid influenza diagnostic test (RIDT) results and has discontinued the use of the RIDT form.
Use this form to report congenital syphilis, neonatal herpes, or ophthalmia neonatorum.
Use this form to report any individual suspected of having active pulmonary or extra-pulmonary TB.
Use this form to report any positive test for TB (IGRA or TST).
Use this form to report varicella. Shingles cases do not need to be reported.
Use this form to report any known or suspected clusters of varicella.
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