Massachusetts DPH is moving provider case reports from paper to an online reporting system. Clinicians who diagnose gonorrhea, syphilis of any stage, HIV/AIDS, varicella, alpha-gal syndrome or hepatitis B in pregnancy, or find a positive TB test or suspect active TB, submit the case through a web form instead of paper. Facilities use the same system for gastrointestinal, respiratory and varicella clusters.
The diagnosing or treating provider, or staff on their behalf, completes the online form for the condition. Facility staff complete the cluster forms for outbreaks in healthcare settings, child care or schools; there is no patient section.
Download the current version from the source each time; forms change without notice.
Infectious Disease Case Report Forms (online)
This form is completed online with Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences, 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.
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Any positive TB test, either an IGRA or a tuberculin skin test, and any person suspected of having active pulmonary or extrapulmonary TB. Both are reported on the Tuberculosis Disease and Infection (LTBI) Reporting Form in the online system, so latent infection and suspected disease use the same form.
No. The varicella case report covers chickenpox, and DPH notes that shingles cases do not need to be reported. Facilities report three or more varicella cases within 42 days as a cluster, one form per cluster, with a new form only once 42 days have passed since the last case.
No. DPH states that paper case reports of chlamydia are no longer required. Gonorrhea and syphilis are reported through their online forms, while chancroid, lymphogranuloma venereum, granuloma inguinale and PID of unknown agent still use a paper case report form posted as a PDF and Word file.