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Communicable Disease Reporting Forms

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Communicable Disease Reporting Forms
Published on: 5/20/2012 12:00 AM
Forms for provider use to assist in reporting communicable diseases can be downloaded in PDF format:
All reportable diseases except TB & DMV
Confidential Morbidity Report (cdph 110a)
Only use this form when reporting Tuberculosis (TB)
Confidential Morbidity Report - TB (cdph 110b)
Use this form for reporting lapses of consciousness or control, Alzheimer’s disease or other conditions which may impair the ability to operate a motor vehicle safely (pursuant to H&S 103900).
Severe Influenza Reporting Form
Changes in reportable communicable diseases for CMR reporting 2010 can be downloaded in PDF format:
A complete list of reportable diseases for CMR reporting can be downloaded in PDF format:
Jill Blake
Public Health Director
Public Health

500 Crown Point Circle
Grass Valley, Ca 95945
Hours: 8am-5pm M-F
Phone: 530.265.1450