Kansas mandated reporters use this one-page KDHE form to report a patient with a suspected or confirmed notifiable disease or condition, as Kansas Statutes section 65-118 and regulation 28-1-2 require. A clinician meets it after suspecting or diagnosing a condition on the Kansas Reportable Diseases List. It goes to KDHE's epidemiology team or the local health department, and reports are confidential by statute.
The health care provider who suspects or diagnoses the condition completes the whole form.
Download the current version from the source each time; forms change without notice.
Kansas Reportable Disease 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.
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Clusters, outbreaks or epidemics of any disease, exotic or newly recognized diseases, possible terrorist acts, unexplained deaths suspected to be due to an unidentified agent, unusual diseases such as mpox or MIS-C, and conditions marked four-hour on the Kansas Reportable Diseases List. Call the KDHE Epidemiology Hotline, even before lab results arrive.
No. KDHE explains that the HIPAA Privacy Rule permits disclosure of protected health information to public health authorities without individual authorization, and K.S.A. 65-118 and K.A.R. 28-1-2 require reporting. The statute also provides immunity from civil or criminal liability for the information reporters share.
Electronic case reporting from EHRs is accepted, and KDHE's KORDS portal currently takes chlamydia, gonorrhea, HIV, syphilis and congenital syphilis. Other conditions are faxed on this form, revised August 2023, to KDHE or the county health department, with four-hour conditions phoned in.