Maryland physicians and other health care providers use the DHMH 1140 to report a reportable disease or condition to their local health department. MDH links it as the reporting form for chlamydia, gonorrhea and syphilis, and it also has blocks for hepatitis serology, HIV/AIDS, TB and other mycobacteria. The local health department may follow up afterward for disease-specific details.
The provider or office staff completes the whole page, and the Reporting Source block (provider name, telephone, facility and date) is required. A checkbox marks forms completed by the local health department; laboratories use DHMH 1281 and DHMH 4492 instead.
Download the current version from the source each time; forms change without notice.
Maryland Confidential Morbidity Report
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 is printed for physicians and other health care providers, not laboratories. Maryland laboratories report on forms DHMH 1281 and DHMH 4492. Providers are still asked to attach copies of lab reports to the 1140 whenever possible.
To your local health department, generally the one for the patient's county of residence, by fax or mail. The form notes that the local health department may contact you after this initial report to request additional disease-specific information, so keep the provider phone number current.
For HIV/AIDS or STI reports, it asks whether you treated any of the patient's partners: whether you saw them in your office, gave medication for a number of partners, or wrote prescriptions for them. It also records risk exposures such as sex with male or female partners and injection drug use.