Maine CDC's Division of Infectious Disease uses this one-page form for provider reports of conditions on the state's notifiable list. A clinician or practice staff member fills it in when a patient has a notifiable disease and faxes it to Maine CDC, attaching lab results if available. Conditions that must be reported immediately go by phone to Maine CDC's 24-hour disease reporting line.
The person reporting at the practice or institution completes the reporting, patient and clinical sections and names the treating provider and practice. No section is reserved for the patient.
Download the current version from the source each time; forms change without notice.
Notifiable Disease Reporting Form
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
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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Yes. Maine CDC supports electronic case reporting (eCR), an automated exchange of case data from the EHR. To start, fill out Maine CDC's eCR registration form, work with your EHR vendor and the eCR team. Facilities in the CMS Promoting Interoperability Program or MIPS must communicate their intent to implement eCR.
Call Maine CDC's disease reporting line, which is staffed 24 hours a day, instead of relying on a faxed form. The current Notifiable Conditions List, dated June 4, 2025, shows which conditions are immediately reportable, and the rules adopted the same day set out reporting requirements.