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  • Where To Fax State Of Nevada Confidential Morbidity Report Form

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Rital Status Social Security Number Patient City Medical Record Number Ethnicity White Black Asian Native American Pacific Islander Other Hispanic Non-Hispanic Primary Language Spoken Single Married Widowed Separated Divorced Unknown Birth Country and Arrival Date Diagnosis Date Incarcerated No Yes Admission Date Disease or Condition Name Onset Date Race Deceased No Yes Discharge Date Date of Death Disease Symptoms No Yes If yes, attach the results or provide the laboratory.

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Nationally Notifiable Diseases Cholera. Cryptosporidiosis. Cyclosporiasis. Giardiasis. Hepatitis A. Legionellosis. Malaria* Salmonellosis.

Hepatitis C. HIV infection. Influenza-related infant deaths. Invasive pneumococcal disease.

How to File File a Complaint Online. Complaint Form - PDF. Print this form, fill it out and fax to (702) 486-6520. Call the Complaint Intake line at (702) 668-3250. Leave a message if no one is available to assist you at the time of your call. Your call will be returned in 48-72 hours.

Reports of known or suspected cases of certain diseases or suspect outbreaks of any illnesses must be immediately reported by telephone to (702) 759-1300, option #2 (available 24 hours).

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.

These diseases include: Anthrax, Botulism, Influenza (novel strains), Measles, Meningococcal disease, Plague, Rabies (Human), Poliovirus infection, Severe Acute Respiratory Syndrome (SARS), Smallpox (variola), Tularemia, Viral hemorrhagic fevers, suspected outbreaks, extraordinary occurrences of illness, and any ...

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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
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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