Colorado providers can fax this 1-page fillable form to report conditions on the state's reportable communicable diseases list. It is not for sexually transmitted infections, chickenpox or animal bites, which have their own forms. It records patient demographics, hospitalization or ED visit, provider, lab accession, specimen and test results, and a hepatitis testing block.
The health care provider or clinic reporting the condition completes the form; the reporter section can be marked as the same as the provider.
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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No. The form states it is not to be used for sexually transmitted infections such as syphilis, chlamydia, gonorrhea or HIV, or for chickenpox or animal bites. CDPHE has separate STI forms that go to a different confidential fax or email.
CDPHE lists automated electronic methods first: the online Reportal, and electronic case reporting for facilities onboarded to that condition. Faxing the general form is the next option. Conditions marked immediate must be phoned in within 4 hours.