Online non-emergency report of suspected child abuse or neglect by a mandated reporter.
- Completed by
- Mandated reporter (physician, nurse, other health practitioner)
- Issued by
- DC Child and Family Services Agency
- Format
- Online only
- Language
- English
DC HAHSTA Case Report Form: HIV, STD and Hepatitis
DC Health's HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA) receives provider case reports of HIV, syphilis, gonorrhea, chlamydia, and viral hepatitis B and C through this online form. A clinician meets it after diagnosing or treating one of these infections in the District. It is filed in the DC Reporting and Surveillance Center (DCRC), the system used for DC's other electronic case reports.
Who completes it
The health care provider who diagnoses or treats the infection completes the whole online report. HAHSTA, not DC Health's general epidemiology division, receives it.
Submitting and payment
- How to submit it
- Submit the HAHSTA Case Report Form online through DCRC. Tuberculosis is reported on the separate TB Case Report Form, reached through the same DCRC link.
- Who pays
- DC Health lists no fee or payment for the report, which DCMR Chapter 22-B2 requires of health care providers.
Good to know
- If the patient is pregnant and has HIV, hepatitis B or syphilis, HAHSTA also expects the Notifiable Disease and Pregnancy Report Form with linkage-to-care and delivery hospital details.
- Infants born to mothers with hepatitis B are handled through DC Health's Postnatal Hepatitis B and HBIG Reporting form.
- All other notifiable conditions go to DC Health's Division of Epidemiology-Disease Surveillance and Investigation on the Notifiable Disease and Condition Case Report Form in DCRC.
Get the official form
Download the current version from the source each time; forms change without notice.
HAHSTA Case Report Form (DCRC)
Get the note ready with Vero
This form is completed online with DC Health, HIV/AIDS, Hepatitis, STD, and TB Administration (HAHSTA), 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.
How this list is checked
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Frequently asked questions
Which infections go on the DC HAHSTA Case Report Form?
HIV, syphilis, gonorrhea, chlamydia, and viral hepatitis B and C. DC Health directs these to HAHSTA rather than to its epidemiology division. Tuberculosis also belongs to HAHSTA but uses its own TB Case Report Form, while all other notifiable conditions go on the general DCRC notifiable disease form.
Is there a paper or fax version of the HAHSTA case report?
DC Health lists the HAHSTA Case Report Form as an online DCRC form and does not post a paper version for these infections. The exception is the Notifiable Disease and Pregnancy Report Form, a one-page fillable PDF that HAHSTA receives by confidential fax for pregnant patients with HIV, hepatitis B or syphilis.