Form 3095 is Georgia's paper case report for notifiable diseases and conditions, required of physicians, laboratories and other health care providers under Georgia Code section 31-12-2. A clinician uses it for conditions reportable within 7 days, as an alternative to entering the case online in SendSS. It goes to the District Health Office and includes a viral hepatitis section for hepatitis A, B and C markers.
The diagnosing provider, or a reporter at the institution, completes the whole form and names the physician in the reporter information block. Boxes marked Local Use Only and State Use Only are left for public health staff.
Download the current version from the source each time; forms change without notice.
Georgia Notifiable Disease/Condition Report Form
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Yes. DPH's disease reporting page offers the Notifiable Disease Report Form for conditions reportable within 7 days, mailed in an envelope marked CONFIDENTIAL to the District Health Office or faxed to its reporting contacts. DPH also accepts the same reports electronically through SendSS. The current form is dated 8-09.
DPH asks providers to report immediately notifiable conditions by calling or faxing the Reporting Contacts at the District Health Office, or by calling the statewide public health reporting line. The Notifiable Disease Reporting Requirements document lists which conditions are immediate and which are reportable within 7 days.