Arkansas health care providers and facilities use this 1-page fillable form to report a mandatory reportable communicable disease or condition to the Arkansas Department of Health. It records the reporting facility, reporter and physician, the disease and onset date, patient details, method of diagnosis and specimen, risk settings, outbreak links, hospitalization and death. Condition-specific boxes cover hepatitis serologies and tickborne disease titers.
The reporting facility or provider completes the whole form and names the patient's physician.
Download the current version from the source each time; forms change without notice.
Communicable Disease Reporting Form
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 Communicable Disease Reporting Form directs influenza reports to ADH's online flu report site instead of the fax form. For other reportable conditions, fax this form and check the ADH Mandatory Reportable Diseases List for the conditions covered.
It asks for the method of diagnosis (clinical or laboratory), the specific test name and result, specimen type and collection date, plus other lab results, treatments and comments with test name, source, result and dates.