Physicians and other providers in New York State use this two-page form to report a suspected or confirmed communicable disease, as the State Sanitary Code (10 NYCRR 2.10) requires. It covers every disease on the state's reportable list, any unusual or emerging disease and any outbreak. The local health department in the patient's county of residence receives it, opens an investigation and records the case status as confirmed, probable or suspect.
The physician holds primary responsibility for reporting, but physician assistants, nurse practitioners, nurses, infection control practitioners, laboratories, schools and health care facilities also report, and the reporter completes both pages. A box at the bottom of page 1 is reserved for the local health department.
Enter the patient's county of residence, or check Non-NYS Resident, and the date of report. Name the disease, using the state's list of reportable diseases, then give the date of diagnosis and the date of illness onset. The county entry determines which local health department handles the case, so it should match the patient's home address rather than the location of your practice.
Record the patient's name and any other names, a guardian's name if the patient is a minor, date of birth, age and country of birth. Add the home address, an Unhoused checkbox, a mailing address if different, email, primary and alternate phone, and primary language. Mark sex or gender (male, female, X or unknown), sexual orientation for patients 12 or older, race with any sub-group, and ethnicity.
Answer whether the patient is alive (with date of death if not), pregnant (with due date) and hospitalized (with hospital name, medical record number and admission and discharge dates). Note recent foreign travel, the countries and the date of return. Check occupation, such as food service, day care, health care, student or correction worker, and the setting where the patient lives or attends, such as a day care facility, school, jail, camp or shelter.
The comments box asks for applicable laboratory data, treatment and recent domestic travel. Include the tests and results that support the diagnosis, including specimen type and dates, and the treatment given or planned. For syphilis, the reporting requirements ask you to specify the stage, and for hepatitis B and C, whether the infection is acute or chronic, which this box can carry.
Leave this box blank. The local health department records the investigator's name, the date the form was received, the investigation start date, whether the case is sporadic, part of a cluster or an outbreak, the case status (confirmed, probable, suspect or unknown) and whether the patient was notified.
Give the reporter's last and first name and title, the name of the provider, facility or laboratory, its National Provider Identifier (NPI) code, address, email and phone. Check the reporter type: health care provider, lab, hospital, school, nursing home, adult care facility, another local or state health department, or other.
Page 2 also prints the reporting rules: which diseases are reportable under 10 NYCRR Part 2, Section 2.1, that unusual diseases and outbreaks also count, who must report, that reports go to the local health department where the patient resides, and that reports are due within 24 hours, with red bold diseases phoned in immediately. It also points HIV and AIDS reporting to form DOH-4189.
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.
Sources for this guide
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Send it to the local health department of the county where the patient lives, not where your practice is. Patients who live outside New York State are marked as non-NYS residents at the top of the form. For New York City residents, the state refers reporters to the NYC Department of Health and Mental Hygiene, whose clinicians use the city's Universal Reporting Form.
Reports are due within 24 hours of diagnosis. Diseases printed in red bold type on the reporting requirements list need prompt action and are phoned to the local health department immediately, with the DOH-389 submitted afterward. For syphilis, any nontreponemal test of 1:16 or higher, any positive prenatal or delivery test, and primary or secondary disease should be reported by phone.
The physician carries primary responsibility. The reporting requirements also name physician assistants, nurse practitioners, nurses, laboratory directors, infection control practitioners, school nurses, day care center directors, nursing homes and hospitals, state institutions and any other location providing health services. Each reporter identifies themselves in the Reporter Information section on page 2.
Every disease listed in 10 NYCRR Part 2, Section 2.1, which the state prints in its Communicable Disease Reporting Requirements, from amebiasis and anthrax to Lyme disease, measles, pertussis, salmonellosis and varicella. Any unusual disease, meaning a newly apparent or emerging disease or syndrome possibly caused by a transmissible agent or microbial toxin, is also reportable, as is any outbreak.