Where clinicians report notifiable diseases, suspected child or adult abuse, vaccine reactions and adverse drug events, state by state, plus the CDC and FDA forms.
Clinicians must report certain diagnoses and suspicions to public health or protective services, and each state sets its own forms and routes. This page covers notifiable disease reports, STI, HIV and TB case reports, and mandated reports of child and adult abuse. Common examples are California's CDPH 110a Confidential Morbidity Report, New York's DOH-389 and the NYC Universal Reporting Form (PD-16) for disease, and New York's LDSS-2221A for suspected child abuse. Federal entries include VAERS, MedWatch Form FDA 3500 and the CDC HIV case report forms.
Much of this reporting has moved online. Pennsylvania requires PA-NEDSS, Illinois uses IDSS, Michigan asks for MDSS wherever possible, and many child and adult abuse reports now go through web portals. Where paper remains, deadlines are short: the LDSS-2221A follows the oral report within 48 hours, and California's BCIA 8572 within 36 hours. Urgent conditions are phoned in first. HIV case reports go to the state or local health department, never to CDC directly. 6 of these forms have a Spanish version.
Collects clinical, MRI and laboratory details on a suspected acute flaccid myelitis case for classification by CDC.
National surveillance report of a Hansen's disease (leprosy) case: demographics, exposure (armadillo contact, residence history), treatment, disabilities and household contacts.
National surveillance report of a malaria case: travel, chemoprophylaxis, species, treatment and adverse events.
Case report for spotted fever rickettsiosis (incl. RMSF), anaplasmosis and ehrlichiosis with clinical and laboratory details.
Reports an adverse event after vaccination; providers are legally required to report events on the VAERS Table of Reportable Events and certain EUA/monkeypox vaccine events.
CDC 50.42AReports HIV infection or AIDS in a patient aged 13 or older at diagnosis to the health department for national HIV surveillance (eHARS).
Reports HIV infection, AIDS, perinatal HIV exposure or seroreversion in a child under 13 to the health department for national HIV surveillance (eHARS).
CDC 55.54Surveillance case report of Kawasaki syndrome: clinical criteria, coronary findings and IVIG treatment.
Health professional's voluntary report of an adverse event, product problem, or medication error involving a drug, biologic, device, dietary supplement, cosmetic or other FDA-regulated product.
Online case report of an Alabama notifiable disease or condition (Immediate/Urgent and Standard notification), including STD and HIV cases.
DHR-FCS-1593Written follow-up by a mandated reporter of an oral report of suspected child abuse or neglect (Code of Alabama 26-14-3).
Report to Adult Protective Services of an adult suspected to be abused, neglected or exploited, with a mandated-reporter checkbox for physicians and practitioners of the healing arts.
Reports a case of a reportable infectious disease (other than STD/HIV) to the State of Alaska Section of Epidemiology.
Written report of suspected child abuse or neglect to the Office of Children's Services.
Report of harm (abuse, neglect, self-neglect, exploitation, abandonment) to a vulnerable adult made to Adult Protective Services.
Reports elevated heavy metal results or toxic exposures (arsenic, cadmium, cobalt, lead, mercury), including blood lead at or above the CDC reference value.
Reports a case of HIV, gonorrhea, syphilis, chlamydia or other reportable STD, with treatment and partner information.
Reports a firearm injury, a condition reportable to the Section of Epidemiology.
Reports a reportable communicable disease (A.A.C. R9-6-202), with disease-specific sections for STI/HIV, syphilis and tuberculosis.
Online submission of a child maltreatment report to the Arkansas Child Abuse Hotline by a mandated reporter.
Reports a case of a mandatory reportable communicable disease or condition to the Arkansas Department of Health, with hepatitis, tickborne and influenza sections.
Reports a bite by a mammal, which Arkansas law requires to be reported immediately for rabies assessment.
CDPH 110aReports a case or suspected case of a reportable communicable disease or condition (Title 17 CCR section 2500), except HIV/AIDS, tuberculosis and DMV-reportable conditions, to the local health department.
BCIA 8572Written mandated report of known or suspected child abuse or neglect under the Child Abuse and Neglect Reporting Act (Penal Code section 11166).
Written mandated report of suspected abuse, neglect or financial abuse of an elder (60+) or dependent adult (WIC 15630).
Cal OES 2-920Written report by a health practitioner who treats a wound or injury caused by assaultive or abusive conduct or a firearm (Penal Code section 11160).
Provider report of active, suspected or confirmed tuberculosis (and TB infection where reportable) to the local health department.
Provider report of a reportable communicable disease or condition (other than STIs/HIV, chickenpox and animal bites).
Provider report of a human animal bite or rabies exposure, with animal status and vaccination details, for rabies follow-up.
Provider case report of syphilis with stage, treatment and pregnancy information.
Written follow-up by a mandated reporter of an oral Careline report of suspected child abuse or neglect.
General case report of a Connecticut reportable disease, emergency illness or health condition (Category 1 and 2) unless a disease-specific form is required.
Reports chancroid, chlamydia, gonorrhea, neonatal herpes or syphilis, with treatment and partner information (CGS 19a-215).
Reports a new HIV diagnosis or AIDS in a patient 13 years or older, with risk, testing history and laboratory data.
Initial report of TB disease (confirmed or suspected) and latent TB infection, with treatment and provider information.
Written referral of suspected abuse, neglect, exploitation or abandonment of an elderly person (60+) to Protective Services for the Elderly (CGS 17b-451).
Online report of suspected child abuse or neglect to the Division of Family Services Child Abuse & Neglect Report Line.
Online non-emergency report of suspected child abuse or neglect by a mandated reporter.
Online case report of HIV, syphilis, gonorrhea, chlamydia and viral hepatitis B and C (TB through the companion TB Case Report Form).
Online case report of a District of Columbia notifiable disease or condition other than HIV, STD, viral hepatitis B/C and TB.
Reports a person bitten by an animal, potentially exposed to rabies, or given rabies post-exposure prophylaxis.
Reports HIV, hepatitis B or syphilis diagnosed in a pregnant woman, with linkage-to-care, treatment and delivery hospital information.
Written (fax) report of suspected child abuse, abandonment or neglect, or abuse, neglect or exploitation of a vulnerable adult, to the Florida Abuse Hotline under Chapters 39 and 415, F.S.
Online submission of a report of suspected child abuse/neglect/abandonment or vulnerable adult abuse/neglect/exploitation to the Florida Abuse Hotline.
Notifies the Florida Department of Health (via the county health department) of a reportable disease or condition diagnosed or suspected by a practitioner under Rule 64D-3.029, F.A.C.
Online referral of suspected child abuse or neglect to Georgia DFCS Child Protective Services by a mandated reporter.
Online case reporting of notifiable diseases and conditions (and HIV adult/pediatric case reports via eACRF/ePCRF) to Georgia DPH.
Paper case report of a notifiable disease or condition (with viral hepatitis lab section) to the district health office.
Online report of suspected abuse, neglect or exploitation of a disabled adult or elder person to Georgia Adult Protective Services.
Written report by a mandated reporter of suspected child abuse or neglect, completed before the oral report and sent after it to satisfy HRS 350-1.1's written-report requirement.
DOH/EPI 11/97Reports a notifiable communicable disease (HAR Title 11, Chapter 156) other than tuberculosis, Hansen's disease, STDs or AIDS to the county DOH office.
DHS 1640 WEBOnline report of suspected abuse, neglect or financial exploitation of a vulnerable adult to Adult Protective Services.
Online report by a mandated reporter of suspected abuse, neglect, self-neglect or exploitation of a vulnerable adult (18+).
Secure web-based case report of suspected or confirmed reportable infectious diseases (demographic, medical and exposure information), routed to the local health department.
Non-emergency online report of suspected child abuse or neglect to the DCFS Child Abuse and Neglect Hotline.
IOCI 25-1279Reports a blood lead test result (patient, test, provider and lab details) to the Illinois Lead Program.
Online report of suspected neglect, battery or exploitation of an endangered adult to Indiana APS.
State Form 56459Case report of chlamydia, gonorrhea, syphilis and other STDs diagnosed or treated by a provider.
470-0665Reporte de sospecha de abuso de menores
Written report of suspected child abuse by a mandatory reporter following the oral report to the Centralized Services Intake Unit.
Clinic case report of chlamydia, gonorrhea or syphilis diagnosis and treatment (including expedited partner therapy) to the Iowa STI Program.
Written report of suspected dependent adult abuse (exploitation, assault, denial of critical care, sexual offense, etc.) to Iowa HHS intake.
Case report of a notifiable disease or condition by a health care provider to KDHE / the local health department.
Provider report of positive tests and treatment for HIV, syphilis, gonorrhea and chlamydia (KSA 65-6002).
Non-emergency online report of suspected abuse, neglect or dependency of a child, or abuse, neglect or exploitation of an adult, in Kentucky.
EPID 200Case report of a disease or condition reportable under 902 KAR 2:020 (also used for confidential STD case reports) to the local health department.
Reports hepatitis B or C infection in a pregnant woman or in a young child (HBV <=2 years, HCV <=3 years), including the newborn/infant born to an infected mother.
Reports an HBsAg-positive pregnant or postpartum mother and the exposed infant's HBIG/hepatitis B vaccine and follow-up for the perinatal hepatitis B prevention program.
Online reporting of reportable diseases and conditions under the Louisiana Sanitary Code (Title 51) by providers, facilities and labs.
Online non-urgent report, or written follow-up to an oral report, of suspected child abuse or neglect by a mandated reporter.
Written report of suspected child abuse/neglect by a mandated reporter, either as the initial report or as the follow-up required within five days of an oral report (Children's Code art. 610 D).
Online non-urgent report of suspected abuse, neglect or exploitation of an adult aged 60 or older.
Online non-emergency report of suspected child abuse or neglect by eligible mandated reporters.
Online report of suspected abuse, neglect or exploitation of an incapacitated or dependent adult to Maine APS.
Report of a notifiable condition or disease (reporter, patient, clinical/lab and provider information) to Maine CDC.
Provider report of a reportable disease or condition (including STDs such as chlamydia, gonorrhea and syphilis) to the local health department.
DHR/SSA 180Mandated reporter's written report of suspected child abuse or neglect following the immediate oral report.
Electronic provider case reports for gonorrhea, syphilis, HIV/AIDS, TB (positive IGRA/TST or suspected active TB), varicella, hepatitis B in pregnancy/infants, alpha-gal syndrome and facility clusters.
Mandated reporter's written report of suspected child abuse or neglect under M.G.L. c.119 s.51A, following the required phone report.
Mandated reporter's written report of suspected abuse, neglect, financial exploitation or self-neglect of a community-dwelling adult aged 60+.
Provider report of congenital syphilis, neonatal herpes or ophthalmia neonatorum in an infant.
Web-based mandatory reporting of communicable diseases by physicians, labs and facilities to the local health department.
Online report of suspected child abuse or neglect by mandated reporters (alternative to the hotline plus DHS-3200).
Report of Actual or Suspected Child Abuse or Neglect (Spanish) DHS-3200-SP
Mandated reporter's written follow-up report to Children's Protective Services after a hotline report of suspected child abuse or neglect.
MDHHS Form 1355Medical provider's case report of HIV infection in an adult or adolescent (in addition to electronic lab reporting).
Provider case report of chlamydia or gonorrhea with treatment information.
General report of a case of most reportable infectious diseases in a Minnesota resident.
Provider case report of syphilis (stage, treatment, pregnancy status) for public health follow-up.
Report of suspected child abuse or neglect to MDCPS Centralized Intake.
Provider report of a reportable disease or condition, with diagnosis, lab and treatment details.
Report of suspected abuse, neglect or exploitation of a vulnerable person under the Vulnerable Persons Act.
Mandated report of suspected child abuse or neglect to the Children's Division hotline unit.
Provider report of a reportable communicable disease or condition (patient, symptoms, diagnostics, treatment, risk factors).
Report of suspected abuse, neglect or exploitation of an elderly person or adult with a disability.
Report of suspected abuse, neglect or exploitation of an older person or vulnerable adult.
Report of suspected child abuse/neglect or abuse, neglect, self-neglect or exploitation of a vulnerable adult.
HHS-9-DCProvider report of a reportable disease, poisoning or organism under 173 NAC 1.
Provider report of a Nevada reportable disease (incl. STDs, HIV/AIDS, animal bites) to the local health authority.
Report of suspected abuse, neglect, exploitation, isolation or abandonment of an older or vulnerable adult.
General report of a reportable infectious disease (other than those with a disease-specific form) under RSA 141-C and He-P 300.
Provider report of a sexually transmitted infection with treatment given and pregnancy status.
Report of suspected abuse, neglect, exploitation or self-neglect of a vulnerable adult under the Adult Protection Law.
Provider case report of HIV infection or AIDS in an adult or adolescent.
Reports a case of a reportable communicable disease (N.J.A.C. 8:57) to the local health department; the form's own label reads 'For Reporting Reportable Communicable Diseases'.
STD-11aProvider case report of syphilis (including pregnancy, neuro/ocular/otic involvement and treatment) to the NJDOH STD Program.
STD-11bProvider case report of gonorrhea (diagnosis and treatment) to the NJDOH STD Program.
STD-11cProvider case report of chlamydial infection (diagnosis and treatment) to the NJDOH STD Program.
Reports that a patient was started on rabies post-exposure prophylaxis, with exposure type, animal, circumstances and treatment given.
State version of the CDC RVCT used to report a TB suspect or case and its initial, current and final status (diagnosis, testing, treatment, outcome).
Clinician report of a diagnosed or treated case of syphilis, gonorrhea, chlamydia or chancroid, including treatment and expedited partner therapy, to the NMDOH STD Program.
Clinician/facility report of a notifiable infectious disease or condition (NMAC 7.4.3.13) to the NMDOH Infectious Disease Epidemiology Bureau.
Online report of suspected abuse, neglect or exploitation of an adult (18+) who cannot protect themselves, for APS intake.
Physician/provider report of a suspected or confirmed communicable disease (10 NYCRR 2.10) to the local health department of the patient's county.
Report of Suspected Child Abuse or Maltreatment (LDSS-2221A-S)
Mandated reporter's signed written report following an oral report to the Statewide Central Register (SCR) of Child Abuse and Maltreatment.
Provider report of reportable diseases and conditions (incl. HIV/AIDS, STIs, TB infection, hepatitis, lead and poisonings) for New York City residents.
Mandated reporter's written report of known or suspected child abuse or neglect (NDCC 50-25.1) to Child Protection Services.
SFN 7630Report of a notifiable disease or condition (NDCC 23-07; NDAC Article 33-06) by a clinician, facility or laboratory to ND HHS.
Mandated reporter's written report of suspected abuse, neglect or exploitation of a vulnerable adult (NDCC 50-25.2) to Vulnerable Adult Protective Services.
Reports a case or suspected case of a reportable infectious disease (OAC Chapter 3701-3) to the local health department; not for HIV/AIDS.
Secure web-based case report of a reportable disease or condition (Title 63 O.S. 1-503; OAC 310:515) by a health care provider to OSDH.
Online report of suspected abuse, neglect or exploitation of a vulnerable adult to Adult Protective Services.
Clinician report of a confirmed or suspected reportable disease or condition (OAR 333-018) to the patient's local health department.
Mandatory electronic case report of a reportable disease or condition (28 Pa. Code Chapter 27) by a health care practitioner or facility to the Department of Health.
Written mandated report of suspected child abuse under the Child Protective Services Law (23 Pa.C.S. Chapter 63) following an oral report to ChildLine.
Report of a reportable disease or condition (including HIV/AIDS and STDs) by the attending physician or laboratory to public health.
Provider report of a reportable communicable disease to the South Dakota Department of Health.
Report of suspected abuse, neglect or exploitation of a child that occurred in Tennessee.
Formulario de Informe PH-1600
Provider (and, for missing data, laboratory) report of a reportable disease or event, including STD treatment and latent TB results, to public health.
Report of suspected abuse, neglect, self-neglect or financial exploitation of a vulnerable adult.
Report of blood lead test results (including point-of-care tests) to the state lead program.
Mandated report of suspected abuse, neglect or exploitation of a child, or of an elderly person or adult with a disability, to DFPS.
Initial provider report of a suspected or confirmed case of a Texas notifiable condition to the local or regional health department.
Provider case report of syphilis, gonorrhea, chlamydia, chancroid and other reportable STIs, with treatment and partner information for disease intervention.
DSHS 13-13674Provider case report of HIV infection or AIDS in a patient aged 13 or older for state HIV surveillance.
Report of suspected child abuse or neglect to DCFS.
Report of suspected abuse, neglect or exploitation of a vulnerable adult to Adult Protective Services.
Provider report of a condition reportable within 24 hours to the Vermont Department of Health.
Reports a patient started on rabies post-exposure prophylaxis, with exposure and animal details.
Mandated report of suspected child abuse or neglect to Child Protective Services.
Physician or facility report of a suspected or confirmed reportable disease or condition to the local health department.
Mandated report of suspected abuse, neglect or exploitation of an adult aged 60+ or an incapacitated adult 18+.
Provider report of a diagnosed sexually transmitted infection (syphilis, gonorrhea, chlamydia, etc.) with treatment and partner information.
Report of suspected abuse, neglect, abandonment or financial exploitation of a vulnerable adult to Adult Protective Services.
DOH 150-002Provider case report of HIV infection or AIDS in an adult or adolescent for state HIV surveillance (eHARS).
Online report of suspected child abuse or neglect to Centralized Intake.
Provider report of a reportable disease case to the local health department.
Mandatory reporter's written follow-up report of suspected abuse, neglect or financial exploitation of an incapacitated adult or facility resident (WV Code 9-6-11).
Provider report of a Category I, II or III reportable communicable disease or condition to the local public health department.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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The CDPH 110a Confidential Morbidity Report is the provider's report of a case or suspected case of a Title 17 reportable disease or condition, sent to the local health department of the patient's residence. It is not used for HIV/AIDS, tuberculosis or DMV-reportable conditions; TB goes on the CDPH 110b. Send it by fax, mail or phone, or through the CalREDIE Provider Portal where the local health department uses it. Urgency ranges from immediately by phone to within 7 calendar days.
After the oral report to the Statewide Central Register of Child Abuse and Maltreatment, the mandated reporter files the signed LDSS-2221A with the local child protective service within 48 hours, at the address the SCR specialist gives. It is now a Word form, with a Spanish version (LDSS-2221A-S) and translations in several other languages, including Chinese, French, Haitian Creole, Korean and Russian.
Cases in New York City residents go to the NYC Department of Health and Mental Hygiene, not to a county health department on the state DOH-389. Providers use the Universal Reporting Form (PD-16), which covers reportable diseases and conditions including HIV/AIDS, STIs, TB infection, hepatitis, lead and poisonings. Submit it online through PRISM, or by mail or fax. Immediately notifiable conditions are phoned to the Provider Access Line.
For certain events, yes. Health care providers are legally required to report adverse events on the VAERS Table of Reportable Events and certain EUA and monkeypox vaccine events, and anyone may report. Use the VAERS online form, or a writable PDF uploaded on the VAERS site. Problems with drugs, devices, biologics and other FDA-regulated products go on MedWatch Form FDA 3500, which is voluntary for clinicians.