Alaska requires health care providers to report all injuries caused by firearms to the Division of Public Health under 7 AAC 27.013. The report is made through an online form linked from the state's Report a Health Condition page; there is no PDF to download. The survey runs 7 pages and opens with the reporting agency's name, phone number and record number.
The health care provider or facility that treats the firearm injury completes the online form, starting with the reporting agency's details.
Download the current version from the source each time; forms change without notice.
Firearm Injury Report Form
This form is completed online with Alaska Department of Health, Section of Epidemiology, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
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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Under 7 AAC 27.013, health care providers must report all firearm-caused injuries to the Division of Public Health. The report goes on the state's online Firearm Injury Report Form, which opens with the reporting agency's name, phone number and record number.
The online form states that reports must be made within 5 working days of the date of diagnosis. There is no paper version to fax; providers use the online form linked from the Report a Health Condition page.
No. It is an online survey only, reached from the Section of Epidemiology's reportable conditions page. Providers fill it in on screen across 7 pages; nothing is downloaded, printed or faxed.