IDCM: Forms
Infectious Disease Control Manual (IDCM) Forms: List of forms and worksheets for communicable disease testing, investigation, and reporting.
IDCM: Forms
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{"data":[["s","s","s","s","s"],["View Form","Form Name","Type","Source","Required or Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-confidential-reportable-disease\">View Form</a></code>","Confidential Reportable Disease Form","General Reporting","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-positive-lab-finding\">View Form</a></code>","Positive Laboratory Finding for Reportable Diseases","General Reporting","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-food-complaint\">View Form</a></code>","Food-Related Alert/Complaint Record","General Reporting","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-food-history\">View Form</a></code>","Food Histories","General Reporting","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-food-illness-log\">View Form</a></code>","Foodborne Illness Complaint Log","General Reporting","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-food-individual-case-history\">View Form</a></code>","Foodborne Disease Report Individual Case History","General Reporting","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-nors-report\">View Form</a></code>","NORS Outbreak Report Form (Foodborne, Person-to-Person, Animal Contact)","Outbreak","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-nors-water-report\">View Form</a></code>","NORS Outbreak Report Form (Waterborne)","Outbreak","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-outbreak-report\">View Form</a></code>","Outbreak Report Template","Outbreak","ODH","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/microbiology/forms/hea-2530\">View Form</a></code>","ODH Laboratory Microbiology Specimen Submission Form","Lab","ODH","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/microbiology/forms/ast-submission-form\">View Form</a></code>","ODH Laboratory Antimicrobial Resistance and Susceptibility Testing Submission Form","Lab","ODH","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/microbiology/forms/food-submission-form\">View Form</a></code>","ODH Laboratory Food Sample Submission Form","Lab","ODH","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/microbiology/forms/rabies-sub-report\">View Form</a></code>","ODH Laboratory Rabies Submission Form","Lab","ODH","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-specimen-couriers\">View Form</a></code>","ODH Lab Specimen Couriers","Lab","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-cdc-specimen-submission\">View Form</a></code>","CDC Specimen Submission Form","Lab","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-cdc-viral-special-pathogens-submission\">View Form</a></code>","CDC Viral Special Pathogens Branch Diagnostic Specimen Submission Form","Lab","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-q-fever-submission\">View Form</a></code>","CDC Q Fever Diagnostic Specimen Submission Form","Lab","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-wi-isp-submission\">View Form</a></code>","Wisconsin State Laboratory of Hygiene Invasive Streptococcus pneumoniae Submission Form","Lab","WI","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-wi-vpd-submission\">View Form</a></code>","Wisconsin State Laboratory of Hygiene Vaccine-Preventable Disease Submission Form","Lab","WI","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-nhgq\">View Form</a></code>","National Hypothesis-Generating Questionnaire","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-enteric-case-investigation\">View Form</a></code>","Ohio Case Investigation Form - Amebiasis, Giardiasis, Salmonellosis, Shiga Toxin-Producing Escherichia coli","Disease-Specific","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-anthrax\">View Form</a></code>","Anthrax Case Investigation Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-babesiosis\">View Form</a></code>","Babesiosis Case Report Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-infant-botulism\">View Form</a></code>","Guide to Investigation of Infant Botulism","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-brucellosis\">View Form</a></code>","Brucellosis Case Report Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-campylobacteriosis\">View Form</a></code>","Ohio Case Investigation Form - Campylobacteriosis","Disease-Specific","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-cholera-vibriosis\">View Form</a></code>","Cholera and Other Vibrio Illness Surveillance Report","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-coccidioidomycosis\">View Form</a></code>","Case Report Form for Coccidioidomycosis (Valley Fever) Enhanced Surveillance","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-2019-ncov\">View Form</a></code>","Human Infection with 2019 Novel Coronavirus Case Report Form","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-cryptosporidiosis\">View Form</a></code>","CryptoNet Case Investigation Form for Cryptosporidiosis Cases","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-cyclosporiasis\">View Form</a></code>","Cyclosporiasis National Hypothesis Generating Questionnaire","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-diphtheria\">View Form</a></code>","Diphtheria Surveillance Worksheet","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-ebola\">View Form</a></code>","Ebola Virus Disease (EVD) Consultation Record","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-stec\">View Form</a></code>","Ground Beef Supplemental Form for Ohio Cases of Shiga Toxin-Producing E. coli","Disease-Specific","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-h-flu\">View Form</a></code>","Haemophilus influenzae Surveillance Worksheet","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-hantavirus\">View Form</a></code>","Hantavirus Disease Case Report Form and Specimen Submission Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-hepatitis\">View Form</a></code>","Viral Hepatitis Case Report Form","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-hiv-aids-adult\">View Form</a></code>","Adult HIV Confidential Case Report Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-hiv-aids-pediatric\">View Form</a></code>","Pediatric HIV Confidential Case Report Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-flu-hospitalization\">View Form</a></code>","Influenza-Associated Hospitalization Confidential Case Report","Disease-Specific","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-flu-pediatric-mortality\">View Form</a></code>","Influenza-Associated Pediatric Mortality Case Report Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-flu-novel\">View Form</a></code>","Human Infection with Novel Influenza A Virus Case Report Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-legionellosis\">View Form</a></code>","Legionellosis Case Report","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-leprosy\">View Form</a></code>","Hansen's Disease (Leprosy) Surveillance Form","Disease-Specific","HRSA","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-leptospirosis\">View Form</a></code>","Leptospirosis Case Report Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-listeriosis\">View Form</a></code>","Listeria Initiative Case Report Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-listeriosis-spanish\">View Form</a></code>","Listeria Initiative Case Report Form (Spanish version)","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-lyme-disease\">View Form</a></code>","Lyme Disease Case Report","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-malaria\">View Form</a></code>","Malaria Case Surveillance Report","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-measles\">View Form</a></code>","Measles Surveillance Worksheet","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-meningococcal-disease\">View Form</a></code>","Enhanced Meningococcal Disease Surveillance Worksheet","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-mers\">View Form</a></code>","Middle East Respiratory Syndrome (MERS) Patient Under Investigation (PUI) Short Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-mosquito\">View Form</a></code>","Mosquito-borne Illness Case Investigation","Disease-Specific","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-mumps\">View Form</a></code>","Mumps Surveillance Worksheet","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-pertussis\">View Form</a></code>","Pertussis Surveillance Worksheet","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-pertussis-death\">View Form</a></code>","Pertussis Death Worksheet","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-plague\">View Form</a></code>","Plague Case Investigation Report","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-polio\">View Form</a></code>","Suspected Polio Case Worksheet","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-psittacosis\">View Form</a></code>","Psittacosis Human Case Surveillance Report","Disease-Specific","ODH","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-q-fever\">View Form</a></code>","Q Fever Case Report","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-rabies-human\">View Form</a></code>","Possible Human Rabies Patient Information","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-rickettsial\">View Form</a></code>","Tickborne Rickettsial Disease Case Report","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-rubella\">View Form</a></code>","Rubella Surveillance Worksheet","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-rubella-congenital\">View Form</a></code>","Congenital Rubella Syndrome Case Report","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-sars\">View Form</a></code>","Severe Acute Respiratory Syndrome (SARS) Domestic Case Reporting Form","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-shigellosis\">View Form</a></code>","Ohio Case Investigation Form - Shigellosis","Disease-Specific","ODH","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-smallpox\">View Form</a></code>","Smallpox Post-Event Surveillance Form","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-isp\">View Form</a></code>","Streptococcus pneumoniae Surveillance Worksheet","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-tetanus\">View Form</a></code>","Tetanus Surveillance Worksheet","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-trichinellosis\">View Form</a></code>","Trichinellosis Surveillance Case Report","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-tuberculosis\">View Form</a></code>","Report of Suspected/Verified Case of Tuberculosis","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-tularemia\">View Form</a></code>","Tularemia Case Investigation Report","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-tularemia-lab-exposure\">View Form</a></code>","Managing Potential Laboratory Exposures to Francisella tularensis","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-typhoid-fever\">View Form</a></code>","Typhoid and Paratyphoid Fever Surveillance Report","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-varicella\">View Form</a></code>","Varicella Surveillance Worksheet","Disease-Specific","CDC","Supplemental"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-varicella-death\">View Form</a></code>","Varicella Death Investigation Worksheet","Disease-Specific","CDC","Required"],["<code><a href=\"https://odh.ohio.gov/know-our-programs/infectious-disease-control-manual/forms/form-yersiniosis\">View Form</a></code>","Ohio Case Investigation Form - Yersiniosis","Disease-Specific","ODH","Supplemental"],[""]],"errors":[],"meta":{"delimiter":",","linebreak":"\r\n","aborted":false,"truncated":false,"cursor":16624}}
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