(FRONT OF CARD)
INSTRUCTIONS
COMMUNICABLE DISEASE REPORT CARD
First
Enter yes only if the
reported disease was
the primary cause of
death.
➤
Social Security Number — No need to
create a number for use here.
Completed cards should be sent to the local health department
Mark both sections.
Middle/Maiden
➤
City
Zip
➤
Ethnic Origin
Hispanic
Non-Hispanic
➤
Patient's Name
Last
Was this
Date of Onset _______/_______/_______
Disease Fatal? Yes No
➤
Patient's Address: Street or RFD No.
Site of Care:
American Indian or Alaska Native
Asian or Pacific Islander
Date of Report _______/_______/_______
Race
White
Black
Age
➤
_____ Years OR _____Months
Hospitalized
For this Disease? Yes No
Phone
________/_______–___________
County
FOR STD ONLY: VOL. EPI. SCREEN
N.C. Department of Health and Human Services – Division of Public Health
NORTH CAROLINA COMMUNICABLE DISEASE REPORT CARD
USE FOR ALL REPORTABLE DISEASES EXCEPT CANCER—REPORT ONLY ONE DISEASE PER CARD
➤
Sex
SSN
M F
____ ____ ____/____ ____/____ ____ ____ ____
ENTER CODE
FOR DISEASE
REPORTED
(see other side)
Birthdate
_____/_____/_____
*Required Information for Codes
6, 9, 13, 23, 25, 27, 38, 54, 55, 58, 61, 68, 200, TB:
Causative Organism: ___________________________________________
[Encephalitis, arboviral (9), Other Foodborne Disease (13), Viral
Hemorrhagic Fever (68)]
Serotype: _____________________________________________________
[Vibrio cholera (6), Hemophilus influenzae (23), Meningitis, Pneumococcal (25),
Meningococcus (27), Salmonella (38), Vibrio, other (55)]
Site of Infection: _______________________________________________
[Hemophilus influenzae (23), Meningococcus (27), Vibrio vulnificus (54),
"VRE" (58), Group A Strep. (61), Chlamydia (200), Tuberculosis (TB)]
COMMENTS:
➤
Particularly important
for respiratory and
enteric diseases.
Indicate where infection
was acquired if
somewhere other than
county of residence. If
acquired in county of
residence, mark
"SAME".
Local Health Department (LHD) should
notify LHD in county
where acquired so an
investigation can be
initiated and control
measures given.
To be completed by LHD. LHD
should obtain surveillance
forms when required (see other
side) and ensure completeness
and accuracy of information.
Location Where Acquired (if other than county of residence)
Active Military
SAME
Public Private
Parent or Guardian (of minors)
Patient is:
Child or Worker
Reported By (Full Name and Title)
in Day Care
Parent of Child
Agency and Address
in Day Care
Foodhandler
Health Care Worker Attending Physician (if not individual reporting case)
None of Above
Address
Phone
State/LHD Use Only:
________/_______–___________
outbreak related:
Surveillance Form
Case Investigation No.
no yes;
Completed Not Required
specify:
Local Health Director’s Signature or Stamp
Clinic No.
__________________
➤





➤



➤
This area of the card is
used by State or local
health department staff to
identify cases associated
with a particular outbreak.
➤
Enter Number for
disease reported from
reverse side of card.
Enter Age in months if
less than 12 mos. and
in years if 12 mos. or
greater. Not necessary
to figure months if over
one year.
Additional information
to be supplied for
specific diseases
noted here and by * on
other side.
DHHS 2124 (Revised 7/03) EPIDEMIOLOGY
Reporters should indicate
in the "COMMENTS"
section the source of
infection, if known,
particularly for foodborne
diseases.
➤
INSTRUCTIONS
COMMUNICABLE DISEASE REPORT CARD
(BACK OF CARD)
➤
65
LATENT, UNKNOWN DURATION
LATE LATENT (> 1 yr)
LATE WITH SYMPTOMS
SECONDARY (skin or
mucosal lesions)
EARLY LATENT (< 1 yr)
740
745
750
720
730
710
SEXUALLY TRANSMITTED DISEASES
*Add’l Information Required on Other Side of Card
➤
Additional information, (site of
infection, causative organism,
serotype) should be entered
on reverse side of card.
OTHER REPORTABLE COMMUNICABLE DISEASES (continued)
PLEASE ENTER CODE NUMBER IN BLOCK ON FRONT OF CARD
Report cards for all shaded diseases should
be accompanied by a properly completed
surveillance form. The local health
department should note on reverse side if
surveillance form is complete or not
required.
Surveillance Form Required
CDC BIOTERRORISM - CATEGORY A
*61
62
760
790
OPHTHALMIA NEONATORUM
GENITO-URINARY (non-PID)
100
500
345
300
*54
PELVIC INFLAMMATORY DISEASE
Other than lab-confirmed CHLAMYDIA:
NONGONOCOCCAL URETHRITIS (NGU)
CHLAMYDIA – Lab confirmed
LYMPHOGRANULOMA VENEREUM
490
400
*200
600
OTHER STDs — REPORT WITHIN 7 DAYS
CHANCROID
GRANULOMA INGUINALE
GONORRHEA
NEUROSYPHILIS
CONGENITAL
REPORT WITHIN 24 HOURS
60 S.A.R.S. (Coronavirus infection) 71
39 SYPHILIS
PRIMARY (lesion present)
900 SHIGELLOSIS
18 STREPTOCOCCAL INFECTION,
20 GROUP A, INVASIVE DISEASE
TOXIC SHOCK SYN., STREPTOCOCCAL
41
40
TOXOPLASMOSIS, CONGENITAL
42
*TB
46
44
30 TYPHOID CARRIER
31 TYPHUS, EPIDEMIC (louse-borne)
70
TYPHOID, ACUTE
TUBERCULOSIS
TRICHINOSIS
64 TETANUS
51 TOXIC SHOCK SYNDROME
21
22
*25
*27
72
32 VACCINIA
144
33 VIBRIO INFECTION, OTHER
28
Q FEVER
ROCKY MOUNTAIN SPOTTED FEVER 35 VIBRIO VULNIFICUS
48
47
*55
RABIES, HUMAN
RUBELLA
36 WHOOPING COUGH
RUBELLA CONGENITAL SYNDROME 37 (PERTUSSIS)
116 SALMONELLOSIS
*38 YELLOW FEVER
Report within 24 hours for diseases in Bold Italics, and 7 days for all other diseases.
8 HEPATITIS B, PERINATAL
66 HEMOPHILUS INFLUENZAE,
INVASIVE DISEASE
*23
56
HEPATITIS A
14
63
HEPATITIS B, ACUTE
15
7 HEPATITIS B CARRIER
115
HEPATITIS C, ACUTE
REPORT IMMEDIATELY
E. COLI, SHIGA TOXINTO LOCAL HEALTH DEPARTMENT
PRODUCING INFECTION
HIV INFECTION
ANTHRAX
3 (including E.coli O157:H7) 53 LEGIONELLOSIS
BOTULISM
10 EHRLICHIOSIS, GRANULOCYTIC 571 LEPTOSPIROSIS
PLAGUE
29 EHRLICHIOSIS, MONOCYTIC
572 LISTERIOSIS
SMALLPOX
69 (E.chaffeensis)
LYME DISEASE
TULAREMIA
43 ENCEPHALITIS, ARBOVIRAL
*9 MALARIA
VIRAL HEMORRHAGIC FEVER *68 (CAL, EEE, WNV, OTHER)
ENTEROCOCCI, VancomycinMEASLES
OTHER REPORTABLE
resistant ("VRE"), from
MENINGITIS, PNEUMOCOCCAL
COMMUNICABLE DISEASES
normally sterile site
*58
ACQUIRED IMMUNODEFICIENCY
MENINGOCOCCAL DISEASE
FOODBORNE DISEASE:
SYNDROME (AIDS)
950
C. perfringens
11 MONKEYPOX
STAPHYLOCOCCAL
12
BRUCELLOSIS
5
OTHER or UNKNOWN
*13 MUMPS
CAMPYLOBACTER INFECTION 50
HANTAVIRUS INFECTION
67 POLIO, PARALYTIC
CHOLERA
*6 HEMOLYTIC UREMIC
PSITTACOSIS
SYNDROME
59
TRANSMISSIBLE SPONGIFORM
ENCEPHALOPATHIES (CJD/vCJD)
CRYPTOSPORIDIOSIS
CYCLOSPORIASIS
DENGUE
DIPHTHERIA
PLEASE ENTER CODE NUMBER IN BLOCK ON FRONT OF CARD
Surveillance Form Required
CDC BIOTERRORISM - CATEGORY A
HEPATITIS C, ACUTE
REPORT IMMEDIATELY
TO LOCAL HEALTH DEPARTMENT
E. COLI, SHIGA TOXINPRODUCING INFECTION
3 (including E.coli O157:H7)
10 EHRLICHIOSIS, GRANULOCYTIC
29 EHRLICHIOSIS, MONOCYTIC
69 (E.chaffeensis)
ANTHRAX
BOTULISM
PLAGUE
SMALLPOX
TULAREMIA
43 ENCEPHALITIS, ARBOVIRAL
VIRAL HEMORRHAGIC FEVER *68 (CAL, EEE, WNV, OTHER)
ENTEROCOCCI, VancomycinOTHER REPORTABLE
resistant ("VRE"), from
COMMUNICABLE DISEASES
normally sterile site
ACQUIRED IMMUNODEFICIENCY
FOODBORNE DISEASE:
SYNDROME (AIDS)
950
C. perfringens
STAPHYLOCOCCAL
BRUCELLOSIS
5
OTHER or UNKNOWN
CAMPYLOBACTER INFECTION 50
HANTAVIRUS INFECTION
CHOLERA
*6 HEMOLYTIC UREMIC
TRANSMISSIBLE SPONGIFORM
ENCEPHALOPATHIES (CJD/vCJD)
CRYPTOSPORIDIOSIS
CYCLOSPORIASIS
DENGUE
53
571
HIV INFECTION
LEGIONELLOSIS
LEPTOSPIROSIS
572 LISTERIOSIS
LYME DISEASE
*9 MALARIA
MEASLES
*58
MENINGITIS, PNEUMOCOCCAL
MENINGOCOCCAL DISEASE
11 MONKEYPOX
12
*13 MUMPS
67 POLIO, PARALYTIC
SYNDROME
59
PSITTACOSIS
31 TYPHUS, EPIDEMIC (louse-borne)
46
Q FEVER
32 VACCINIA
70
66 HEMOPHILUS INFLUENZAE,
33 VIBRIO INFECTION, OTHER
INVASIVE DISEASE
*23 RABIES, HUMAN
ROCKY
MOUNTAIN
SPOTTED
FEVER
35 VIBRIO VULNIFICUS
HEPATITIS A
14
63
RUBELLA
36
HEPATITIS B, ACUTE
15
WHOOPING COUGH
7 HEPATITIS B CARRIER
115 RUBELLA CONGENITAL SYNDROME 37 (PERTUSSIS)
8 HEPATITIS B, PERINATAL
SEXUALLY TRANSMITTED DISEASES
REPORT WITHIN 24 HOURS
60 S.A.R.S. (Coronavirus infection) 71
SYPHILIS
900 SHIGELLOSIS
39
PRIMARY (lesion present)
18 STREPTOCOCCAL INFECTION,
20 GROUP A, INVASIVE DISEASE
*61 SECONDARY (skin or
mucosal lesions)
64 TETANUS
40
EARLY LATENT (< 1 yr)
51 TOXIC SHOCK SYNDROME
41 LATENT, UNKNOWN DURATION
21
TOXIC SHOCK SYN., STREPTOCOCCAL
65 LATE LATENT (> 1 yr)
22
TOXOPLASMOSIS, CONGENITAL
62 LATE WITH SYMPTOMS
*25
TRICHINOSIS
42 NEUROSYPHILIS
*27
CONGENITAL
TUBERCULOSIS
*TB
72
GONORRHEA
TYPHOID, ACUTE
44
28
GENITO-URINARY (non-PID)
144 OPHTHALMIA NEONATORUM
30 TYPHOID CARRIER
56
DIPHTHERIA
*Add’l Information Required on Other Side of Card
OTHER REPORTABLE COMMUNICABLE DISEASES (continued)
116 SALMONELLOSIS
*38 YELLOW FEVER
*55
*54
47
48
CHANCROID
GRANULOMA INGUINALE
710
720
730
740
745
750
760
790
300
345
100
500
OTHER STDs — REPORT WITHIN 7 DAYS
CHLAMYDIA – Lab confirmed
*200
LYMPHOGRANULOMA VENEREUM
Other than lab-confirmed CHLAMYDIA:
NONGONOCOCCAL URETHRITIS (NGU)
PELVIC INFLAMMATORY DISEASE
600
400
490
Report within 24 hours for diseases in Bold Italics, and 7 days for all other diseases.
PLEASE ENTER CODE NUMBER IN BLOCK ON FRONT OF CARD
Surveillance Form Required
CDC BIOTERRORISM - CATEGORY A
HEPATITIS C, ACUTE
REPORT IMMEDIATELY
TO LOCAL HEALTH DEPARTMENT
E. COLI, SHIGA TOXINPRODUCING INFECTION
3 (including E.coli O157:H7)
10 EHRLICHIOSIS, GRANULOCYTIC
29 EHRLICHIOSIS, MONOCYTIC
69 (E.chaffeensis)
ANTHRAX
BOTULISM
PLAGUE
SMALLPOX
TULAREMIA
43 ENCEPHALITIS, ARBOVIRAL
VIRAL HEMORRHAGIC FEVER *68 (CAL, EEE, WNV, OTHER)
ENTEROCOCCI, VancomycinOTHER REPORTABLE
resistant ("VRE"), from
COMMUNICABLE DISEASES
normally sterile site
ACQUIRED IMMUNODEFICIENCY
FOODBORNE DISEASE:
SYNDROME (AIDS)
950
C. perfringens
STAPHYLOCOCCAL
BRUCELLOSIS
5
OTHER or UNKNOWN
CAMPYLOBACTER INFECTION 50
HANTAVIRUS INFECTION
CHOLERA
*6 HEMOLYTIC UREMIC
TRANSMISSIBLE SPONGIFORM
ENCEPHALOPATHIES (CJD/vCJD)
CRYPTOSPORIDIOSIS
CYCLOSPORIASIS
DENGUE
DIPHTHERIA
*Add’l Information Required on Other Side of Card
OTHER REPORTABLE COMMUNICABLE DISEASES (continued)
SYNDROME
53
571
HIV INFECTION
LEGIONELLOSIS
LEPTOSPIROSIS
572 LISTERIOSIS
LYME DISEASE
*9 MALARIA
MEASLES
*58
MENINGITIS, PNEUMOCOCCAL
MENINGOCOCCAL DISEASE
11 MONKEYPOX
12
*13 MUMPS
67 POLIO, PARALYTIC
59
PSITTACOSIS
31 TYPHUS, EPIDEMIC (louse-borne)
46
Q FEVER
32 VACCINIA
70
66 HEMOPHILUS INFLUENZAE,
33 VIBRIO INFECTION, OTHER
INVASIVE DISEASE
*23 RABIES, HUMAN
ROCKY
MOUNTAIN
SPOTTED
FEVER
35 VIBRIO VULNIFICUS
HEPATITIS A
14
63
36 WHOOPING COUGH
HEPATITIS B, ACUTE
15 RUBELLA
7 HEPATITIS B CARRIER
115 RUBELLA CONGENITAL SYNDROME 37 (PERTUSSIS)
56
8 HEPATITIS B, PERINATAL
SEXUALLY TRANSMITTED DISEASES
REPORT WITHIN 24 HOURS
60 S.A.R.S. (Coronavirus infection) 71
SYPHILIS
900 SHIGELLOSIS
39
PRIMARY (lesion present)
18 STREPTOCOCCAL INFECTION,
20 GROUP A, INVASIVE DISEASE
*61 SECONDARY (skin or
mucosal lesions)
64 TETANUS
40
EARLY LATENT (< 1 yr)
51 TOXIC SHOCK SYNDROME
41 LATENT, UNKNOWN DURATION
21
TOXIC SHOCK SYN., STREPTOCOCCAL
65 LATE LATENT (> 1 yr)
22
TOXOPLASMOSIS, CONGENITAL
62 LATE WITH SYMPTOMS
*25
TRICHINOSIS
42 NEUROSYPHILIS
*27
CONGENITAL
TUBERCULOSIS
*TB
72
GONORRHEA
TYPHOID, ACUTE
44
28
GENITO-URINARY (non-PID)
144 OPHTHALMIA NEONATORUM
30 TYPHOID CARRIER
116 SALMONELLOSIS
*38 YELLOW FEVER
Report within 24 hours for diseases in Bold Italics, and 7 days for all other diseases.
CHANCROID
GRANULOMA INGUINALE
710
720
730
740
745
750
760
790
300
345
100
500
*55
OTHER STDs — REPORT WITHIN 7 DAYS
*54
CHLAMYDIA – Lab confirmed
LYMPHOGRANULOMA VENEREUM
*200
600
47
Other than lab-confirmed CHLAMYDIA:
NONGONOCOCCAL URETHRITIS (NGU)
400
48
PELVIC INFLAMMATORY DISEASE
490
FOR STD ONLY: VOL. EPI. SCREEN
Patient's Name
Last
N.C. Department of Health and Human Services – Division of Public Health
NORTH CAROLINA COMMUNICABLE DISEASE REPORT CARD
USE FOR ALL REPORTABLE DISEASES EXCEPT CANCER—REPORT ONLY ONE DISEASE PER CARD
Sex
SSN
First
Middle/Maiden
M F
____ ____ ____/____ ____/____ ____ ____ ____
Was this
Date of Onset _______/_______/_______ Disease Fatal? Yes No
Patient's Address: Street or RFD No.
Ethnic Origin
American Indian or Alaska Native
Hispanic
City
Asian or Pacific Islander
Non-Hispanic
Date of Report _______/_______/_______
Race
White
Black
ENTER CODE
FOR DISEASE
REPORTED
(see other side)
Birthdate
_____/_____/_____
Age
_____ Years OR _____Months
Site of Care:
Active Military
Public Private
*Required Information for Codes
6, 9, 13, 23, 25, 27, 38, 54, 55, 58, 61, 68, 200, TB:
Causative Organism: ___________________________________________
[Encephalitis, arboviral (9), Other Foodborne Disease (13), Viral
Hemorrhagic Fever (68)]
Serotype: _____________________________________________________
[Vibrio cholera (6), Hemophilus influenzae (23), Meningitis, Pneumococcal (25),
Meningococcus (27), Salmonella (38), Vibrio, other (55)]
Site of Infection: _______________________________________________
[Hemophilus influenzae (23), Meningococcus (27), Vibrio vulnificus (54),
"VRE" (58), Group A Strep. (61), Chlamydia (200), Tuberculosis (TB)]
COMMENTS:
Zip
Hospitalized
For this Disease? Yes No
Phone
________/_______–___________
County
Location Where Acquired (if other than county of residence)
SAME
Parent or Guardian (of minors)
Patient is:
Child or Worker
Reported By (Full Name and Title)
in Day Care
Parent of Child
Agency and Address
in Day Care
Foodhandler
Health Care Worker Attending Physician (if not individual reporting case)
None of Above
Address
Phone
State/LHD Use Only:
________/_______–___________
outbreak related:
Surveillance Form
Case Investigation No.
no yes;
Completed Not Required
specify:
Local Health Director’s Signature or Stamp
Clinic No.
__________________
DHHS 2124 (Revised 7/03) EPIDEMIOLOGY
FOR STD ONLY: VOL. EPI. SCREEN
Patient's Name
Last
N.C. Department of Health and Human Services – Division of Public Health
NORTH CAROLINA COMMUNICABLE DISEASE REPORT CARD
USE FOR ALL REPORTABLE DISEASES EXCEPT CANCER—REPORT ONLY ONE DISEASE PER CARD
Sex
SSN
First
Middle/Maiden
M F
____ ____ ____/____ ____/____ ____ ____ ____
Was this
Date of Onset _______/_______/_______ Disease Fatal? Yes No
Patient's Address: Street or RFD No.
Ethnic Origin
American Indian or Alaska Native
Hispanic
City
Asian or Pacific Islander
Non-Hispanic
Date of Report _______/_______/_______
ENTER CODE
FOR DISEASE
REPORTED
(see other side)
Birthdate
_____/_____/_____
Race
White
Black
Age
_____ Years OR _____Months
Site of Care:
Active Military
Public Private
*Required Information for Codes
6, 9, 13, 23, 25, 27, 38, 54, 55, 58, 61, 68, 200, TB:
Causative Organism: ___________________________________________
[Encephalitis, arboviral (9), Other Foodborne Disease (13), Viral
Hemorrhagic Fever (68)]
Serotype: _____________________________________________________
[Vibrio cholera (6), Hemophilus influenzae (23), Meningitis, Pneumococcal (25),
Meningococcus (27), Salmonella (38), Vibrio, other (55)]
Site of Infection: _______________________________________________
[Hemophilus influenzae (23), Meningococcus (27), Vibrio vulnificus (54),
"VRE" (58), Group A Strep. (61), Chlamydia (200), Tuberculosis (TB)]
COMMENTS:
DHHS 2124 (Revised 7/03) EPIDEMIOLOGY
Zip
Hospitalized
For this Disease? Yes No
Phone
________/_______–___________
County
Location Where Acquired (if other than county of residence)
SAME
Parent or Guardian (of minors)
Patient is:
Child or Worker
Reported By (Full Name and Title)
in Day Care
Parent of Child
Agency and Address
in Day Care
Foodhandler
Health Care Worker Attending Physician (if not individual reporting case)
None of Above
Address
Phone
State/LHD Use Only:
________/_______–___________
outbreak related:
Surveillance Form
Case Investigation No.
no yes;
Completed Not Required
specify:
Local Health Director’s Signature or Stamp
Clinic No.
__________________
REPORTABLE COMMUNICABLE DISEASES IN NORTH CAROLINA
The Division of Public Health, Department of Health and Human Services, is authorized by law (G.S. 130A-133 through 130A-143)
to collect reports of cases of communicable diseases listed below. G.S. 130A-135 requires licensed physicians to report cases and
suspected cases of reportable communicable diseases and conditions in persons who have consulted them professionally.
AIDS
Anthrax
Botulism*
Brucellosis
Campylobacter Infection*
Chancroid
Chlamydia
Cholera*
Cryptosporidiosis*
Cyclosporiasis*
Dengue
Diphtheria
E. coli, Shiga Toxinproducing Infection
(including E.coli
O157:H7)*
Ehrlichiosis, granulocytic
Ehrlichiosis, monocytic
(E. chaffeensis)
Encephalitis, Arboviral
(CAL, EEE, WNV,
other)
Enterococci, Vancomycinresistant (“VRE”), from
normally sterile site
Foodborne Disease:*
- C. perfringens
- Staphylococcal
- Other/Unknown
Gonorrhea, all sites
Granuloma
Inguinale
Hantavirus Infection
Hemolytic Uremic
Syndrome
Hemophilus influenzae,
Invasive Disease
Hepatitis A*
Hepatitis B, Acute
Hepatitis B Carrier
Hepatitis B, Perinatal
Hepatitis C, Acute
HIV Infection
Legionellosis
Leptospirosis
Listeriosis
Lyme Disease
Lymphogranuloma
Venereum
Malaria
Measles
Meningitis, Pneumococcal
Meningococcal Disease
Monkeypox
Mumps
Nongonococcal Urethritis
(NGU), other than labconfirmed Chlamydia
Plague
Pelvic Inflammatory Disease
Polio, paralytic
Psittacosis
Q Fever
Rabies, Human
Rocky Mountain
Spotted Fever
Rubella
Rubella, Congenital
Syndrome
Salmonellosis*
S.A.R.S. (Coronavirus
Infection)
Shigellosis*
Smallpox
Streptococcal Infection,
Group A, Invasive Disease
Syphilis, all stages
Tetanus
Toxic Shock Syndrome
Toxic Shock Syndrome,
Streptococcal
Toxoplasmosis,
Congenital
Transmissible
Spongiform
Encephalopathies
(CJD/vCJD)
Trichinosis*
Tuberculosis
Tularemia
Typhoid, Acute*
Typhoid Carrier*
Typhus, Epidemic
(louse-borne)
Vaccinia
Vibrio Infection,
Other*
Vibrio vulnificus*
Viral Hemorrhagic
Fever
Whooping Cough
(Pertussis)
Yellow Fever
Bioterrorism Potential: Diseases underlined in the above list (ANTHRAX, BOTULISM, PLAGUE, SMALLPOX, TULAREMIA
and VIRAL HEMORRHAGIC FEVER) have been identified by the U.S. Centers for Disease Control and Prevention as having high
potential for use as bioweapons. IMMEDIATELY report any suspected or confirmed case to the Local Health Department, or to the
General Communicable Disease Control Branch 24-hour number with pager link after hours at 919-733-3419.
Report diseases in Bold Italics within 24 hours (by phone and card), and other diseases within 7 days (by card).
PLEASE NOTE: Diseases reportable within 24 hours (in bold italic letters) have potential for epidemic spread or require rapid action.
An immediate telephone report to the local health department is required as well as completion of the communicable disease report
card and a surveillance form (for selected diseases) within 7 days.
*Diseases listed with an asterisk: Restaurants and other food or drink establishments are required to report all outbreaks or suspected
outbreaks of foodborne illness in customers or employees.
Procedure for Reporting:
Cases should be reported on the communicable disease report card (DHHS 2124) available from local health departments. If unsuccessful, as a last
resort, please call the Surveillance Unit of the General Communicable Disease Control Branch at 919-733-3419. Surveillance forms required for
some diseases (indicated by shading on the back of the communicable disease report card) are also available from the same sources. Physicians
should forward case reports to their local health department, which will then forward the report to the Communicable Disease and Epidemiology
Section.
Telephone Reports:
Please report the following occurrences to the local health department:
1. All diseases that are required to be reported within 24 hours;
2. Disease occurrences of unusual significance, incidence, or concentration which may merit an epidemiologic evaluation, including nosocomial
outbreaks, diarrheal disease, rash illness, day care outbreaks, etc.; and
3. Foodborne and waterborne outbreaks – suspected common source outbreaks.
Telephone reports should include the following information:
a. Disease (diagnosed or suspected)
b. Date of onset and symptoms
c. Patient name, other identifying info.
d. Patient’s address
e. Source, if known
f. Patient’s age, sex, and race/ethnicity
g. Laboratory confirmed (yes or no)
h. Patient’s physician
i. Name and phone number of person making report
For further information or assistance regarding communicable diseases, physicians should first contact their local health department.
Local health department staff may contact the General Communicable Disease Control Branch at 919-733-3419.
Rev.4/6/04