Public Health Templates

This form is used for reporting cases of cysticercosis and taeniasis 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 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 tracking and following up with individuals who have been in contact with someone diagnosed with meningococcal disease in 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 Leptospirosis in California. It helps health authorities track and respond to the spread of the disease.

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 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 document provides instructions for completing a Tetanus Surveillance Worksheet, which is used to monitor cases of tetanus and track relevant information.

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 reporting cases of Listeria infection as part of the CDC Listeria Initiative.

This form is used for reporting cases of typhoid carriers 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 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 reporting foodborne disease outbreaks in California. It provides instructions on how to complete and submit Form CDPH8567.

This document provides instructions for completing the Tuberculosis Surveillance Report Form in the state of Connecticut. It explains how to accurately document and report cases of tuberculosis for surveillance purposes.

This form is used for reporting confidential information related to adult HIV cases in the state of Connecticut.

This form is used for reporting cases of Zika virus in Connecticut.

This Form is used for recording immunization records in the state of Delaware.

This document is a checklist used in California for maintaining public health case records. It ensures that all necessary information is included in the records for efficient record-keeping and data analysis.

This form is used for filing complaints against food establishments in Arkansas.

This form is used for reporting disinfection and turbidity levels in surface water systems serving a population size of 10,000 in Missouri.

This form is used for requesting a 4-log certification in Massachusetts.

This Form is used for reporting incidents related to alcohol, drugs, and personal conduct in the state of Georgia, United States.

This form is used for investigating cases of tularemia in the state of Indiana.

This Form is used for investigating anthrax cases in Indiana.

This Form is used for reporting cases of Lyme Disease in the state of Indiana.

This Form is used for conducting public health home visits in Illinois to assess environmental health and identify potential lead exposure risks.

This Form is used for certifying lead and copper consumer notice compliance in the state of Georgia.

This form is used for investigating leptospirosis cases in the state of Indiana.

This Form is used for recording vaccine administration for children and teens in Indiana.

This document certifies the Consumer Confidence Report (CCR) for the state of Kentucky. The CCR provides important information about the quality of drinking water in Kentucky, including the source, treatment methods, and any contaminants detected.

This form is used for assessing Level 1 compliance with the Revised Total Coliform Rule in Kentucky.