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Get NC DHHS 2124 2008

Municable Disease Branch • Immunization Branch (WCH Section) Disease Control Division Buncombe County Department of Health 40 Coxe Avenue Asheville NC 28801 Phone: (828) 250-5109 Fax: (828) 250-6169 Confidential Communicable Disease Report—Part 1 NC DISEASE CODE DATE OF SYMPTOM ONSET (see reverse side for code) Patient’s First Name Middle Birthdate (mm/dd/yyyy) Last Sex Age F SSN State Asian Other Unknown Did patient die from this disease? Yes No Alias Patient Identifier Tra.

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