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Ng 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). CONDITION BEING REPORTED Patient Name - Last Name First Name MI Home Address: Number, Street Apt./Unit No. City State Home Telephone Number Cell Telephone Number Yes ZIP Code Primary Language Pregnant? No Hispanic/Latino Non-Hispanic/Non-Latino Race (check all that apply) Work Telephone Number Email Address Birth D.

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Some examples of the reportable communicable diseases include Hepatitis A, B & C, influenza, measles, and salmonella and other food borne illnesses.

CDC monitors about 120 of these notifiable diseases and conditions at the national level.

Reportable diseases are divided into several groups: Mandatory written reporting: A report of the disease must be made in writing. Examples are gonorrhea and salmonellosis. Mandatory reporting by telephone: The provider must make a report by phone. Examples are rubeola (measles) and pertussis (whooping cough).

To report a communicable disease, you may contact the Epidemiology Unit by phone at (619) 692-8499. For urgent matters on evenings, weekends or holidays, dial (858) 565-5255 and ask for the Epidemiology Unit duty officer. You can also download and print a Confidential Morbidity Report form and fax it to (858) 715-6458.

California Local Health Department Contact Information for Health Care Providers/Labs to Report Communicable Diseases and Submit Confidential Morbidity Report (CMR) forms. If unable to reach the LHD, Healthcare providers may contact the CDPH Duty Officer at (916) 328-3605.

If you have questions regarding reporting or need to report a disease urgently, please call 408-885-4214.

The Confidential Morbidity Report (CMR) is the form used to report most diseases and other conditions to the Public Health Department. Other CMR forms are available to report suspected cases of tuberculosis and conditions reportable to the California Department of Motor Vehicles.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232