Follow the steps to fill out the reporting form accurately.

1. Click ‘Get Form’ button to access the reporting form and open it in an editable format.
2. In the first section, enter the name of your reporting agency along with your agency's telephone number.
3. Provide details about the person reporting by entering their name in print, followed by their Ontario health card number.
4. Fill in the patient information, which includes the patient's last name, first name, date of birth, age, gender, and complete address, including city and postal code.
5. Record the patient's home telephone number and an alternative contact number if available.
6. Indicate the patient's occupation and the name of their school or child care centre, if applicable.
7. In the Disease Information section, specify the disease being reported and state the specimen type.
8. Enter the onset date of the disease and the date the specimen was collected. If related to STIs, include the STI lab specimen number.
9. In the Treatment History section, provide details of the treatment given, including any relevant treatment dates. If no treatment information is available, select the corresponding option.
10. Indicate whether the patient was hospitalized, and if so, provide the admission date, the name of the hospital, and the discharge date.
11. Fill in the Physician Information, including the physician's name, specialty, office address, city, postal code, and their telephone number.
12. At the end of the form, indicate the date of notification, and ensure the reporter's signature is included, followed by printing their name.
13. Once you have completed all applicable fields, save your changes, and consider downloading or printing the form for your records before submitting it as instructed.

Complete the Canada Ottawa Public Health Reporting Form online today to support public health efforts.