Disease Reporting Requirements for Health Care Providers and Laboratories
Disease reporting is the foundation of public health surveillance. The reporting of specific diseases is critical to public health and required by law.
Title 17, California Code of Regulation, Section 2500 (Division 1, Chapter 4, Article 1)
• §2500 (b) It shall be the duty of every health care provider, knowing of or in attendance on a case or suspected case of any of the diseases or conditions listed, to report to the local health officer for the jurisdiction where the patient resides. Where no health care provider is in attendance, any individual having knowledge of a person who is suspected to be suffering from one of the diseases or conditions listed may make such a report to the local health officer for the jurisdiction where the patient resides.
• §2500 (c) The administrator of each health facility, clinic or other setting where more than one health care provider may know of a case, a suspected case or an outbreak of disease within the facility shall establish and be responsible for administrative procedures to assure that reports are made to the local health officer.
• §2500 (a)(14) ‘Health care provider’ means a physician and surgeon, a veterinarian, a podiatrist, a nurse practitioner, a physician assistant, a registered nurse, a nurse midwife, a school nurse, an infection control practitioner, a medical examiner, a coroner, or a dentist.
• §2505 requires laboratories to report laboratory testing results, including molecular and pathologic results, suggestive of diseases of public health importance to the local health department. Laboratories must report any initial findings as well as any subsequent findings. In addition, laboratories must report negative test results or findings when requested by the Department or a local health officer
• §2508 requires anyone in charge of a public or private school, kindergarten, boarding school, or day nursery to report the presence or suspected presence of any of the reportable diseases to the local health department.
Failure to report is a misdemeanor (Health & Safety Code §120295) and is a citable offense under the Medical Board of California Citation and Fine Program (Title 16, CCR, §1364.10 and 1364.11).
All reports remain confidential.
> September 2022 Changes: Providers (PDF, 255KB)(PDF, 129KB)
1.2 Lab Reportable Disease (PDF)
> Sept 2023 Lab Reporting COVID Influenza RSV(PDF, 224KB)
> September 2022 Changes: Laboratories (PDF, 240KB)
2. Diseases Requiring Immediate or Urgent Provider Reporting
|2.1 REPORT IMMEDIATELY BY PHONE
During Business Hours: (559) 600-3200 After Hours: (559) 600-3111
Be prepared to provide Patient Name, DOB, and Symptoms of confirmed or suspected cases
A CMR is still required to be submitted (via Provider Portal or fax at 559-600-7607) after report is made by phone.
- Anthrax, human or animal
- Botulism (Infant, Foodborne, Wound, Other)
- Brucellosis, human
- Ciguatera Fish Poisoning
- Domoic Acid Poisoning (Amnesic Shellfish Poisoning)
- Flavivirus infection of undermined species
- Foodborne Disease (when two or more cases or suspected cases of foodborne disease from separate households are suspected to have the same source of illness)
- Hemolytic Uremic Syndrome
- Influenza due to novel strains (human)
- Measles (Rubeola)
- Meningococcal Infections
- Middle East Respiratory Syndrome (MERS)
- Novel Virus with Pandemic Potential
- Paralytic Shellfish Poisoning
- Plague, Human or Animal
- Rabies, Human or Animal
- Scombroid Fish Poisoning
- Shiga Toxin (detected in feces)
- Smallpox (Variola)
- Tularemia, human
- Viral Hemorrhagic Fevers, human or animal (Crimean-Congo, Ebola, Lassa, and Marburg viruses)
- Occurrence of any unusual disease
- Outbreak of any disease (including diseases not listed in §2500)
*Examples of Unusual Diseases: Serious, unexpected, unexplained acute illness with atypical host characteristics; Syndrome of uncertain etiology which a health care provider has reason to believe could possibly be caused by a transmissible infectious agent or microbial toxin; Single case of communicable disease long absent from the population or disease not previously recognized; Rare or emerging disease; Unexpected increase in an illness out of season; Unusual age distribution for disease; Cluster of cases presenting similarly during same time period, especially from same geographic areas (e.g., patients went to same event or work in same building); Occurrences such as epidemics, poisonings, fires, major accidents, death from unnatural causes or other catastrophes and unusual occurrences which threaten the welfare, safety or health of persons. Please note the above list is not all-inclusive, when in doubt- report.
2.2 REPORT WITHIN ONE WORKING DAY
By Fax: CMR to (559) 600-7607 By Provider Portal (electronic CMR),
Fill forms out completely
For TUBERCULOSIS: Phone: (559) 600-3413Fax:(559) 600-7602
- Candida auris, colonization or infection
- Carbapenem-Resistant Enterobacteriaceae (CRE)
- Chickenpox (Varicella) (outbreaks, hospitalizations, and deaths)
- Chikungunya Virus Infection
- Dengue Virus Infection
- Encephalitis, specify etiology (Viral, Bacterial, Fungal, Parasitic)
- Escherichia coli: Shiga toxin-producing (STEC), including E. coli0157:H7
- Foodborne Disease
- Haemophilus influenzae, invasive disease (only in persons less than 5 years of age)
- Hantavirus Infections
- Hepatitis A, acute infection
- Meningitis, specify etiology (Viral, Bacterial, Fungal, Parasitic)
- Monkey Pox or orthopox virus infection
- Paratyphoid Fever
- Pertussis (whooping cough)
- Poliovirus Infection
- Q Fever
- Relapsing Fever
- Salmonellosis (other than Typhoid Fever)
- Syphilis (all stages, including congenital)
- Tuberculosis (TB)
- Typhoid Fever, Cases and Carriers
- Vibrio Infections
- West Nile Virus Infection
- Yellow Fever
- Zika Virus Infection
- Pediatric Acute Hep of Unknown Etiology
Please see complete Title 17 list for timing requirements on all other diseases (section 1).
3. How to Report
3.1 General Reporting Guidelines
A Case Reporting and Confidential Morbidity Reporting Form (CMR) must be submitted. In general, there are 2 ways to do this: Provider Portal (electronic CMR) or Fax. Please note some diseases have specific requirements as outlines in section 3.2 Specific Disease Guidelines.
3.1.1 Provider Portal. *preferred method
3.1.2 Faxed Forms
CMRs may be submitted using the appropriate form below and faxed (please do not email) to the number listed on the form.
- CMR Form (PDF, 2MB) (used to report all diseases and conditions excluding COVID-19, TB, DMV related conditions, Bite Reports/Rabies, and HIV/AIDS. See below for more information on reporting these conditions)
- DMV CMR Form(PDF, 1MB) (use only to report conditions which may impair a person’s ability to operate a motor vehicle to the Department of Motor Vehicles)
3.2 Specific Disease Guidelines
3.2.1 TB Reporting
Please go to the TB Reporting page for information on reporting TB
3.2.2 MDRO, CP-CRPA, CP-CRAB, and CP-CRE
- Any case or suspected case of meningitis should be reported by CMR.
- Meningitis should be reported even if no organism has been identified as the etiology.
- Organisms that are not normally reportable (Enterovirus, Herpes, etc.) should still be reported as meningitis when detected in CSF or otherwise identified as the etiology of meningitis.
- Any suspicion or detection of a meningococcal infection (neisseria meningitidis) should be immediately reported by telephone.
- If after hours, please contact our on-call staff at (559) 600-3111 to report as soon as possible.
3.2.4 COVID-19, Influenza and RSV
- Not required to submit a CMR or call to report non-outbreak associated COVID-19 cases to the Fresno County Department of Public Health.
- Report all novel-strain (non-seasonal) influenza cases, Lab-Confirmed COVID-19 or Influenza-associated fetal pediatric cases <18 years and RSV-associated fetal cases <5.
- Report acute Respiratory outbreaks (Institution/congregated setting with at least 1 lab confirmed case in setting with 2 or more influenza-like-illnesses or acute-respiratory illnesses within 72hrs; Community setting assessed as having public health importance).
- Testing Facilities certified under CLIA to perform non-waived testing//Laboratories (e.g., Labs, hospitals, pharmacies, healthcare systems, hospital outpatient clinics) must report all laboratory-based SARS-CoV-2, influenza virus, and RSV NAAT and non-NAAT/Antigen diagnostic testing results, including positive and non-positive.
- Community based testing facilities (e.g., skilled nursing facilities, long-term care centers, and independent providers offices) must report NATT tests but not Antigen tests.
- Send questions on Influenza and RSV reporting and testing setting determination to firstname.lastname@example.org .
3.2.5 Multisystem Inflammatory Syndrome in Children (MIS-C)
Report cases that meet the Centers for Disease Control and Prevention (CDC) case definition of Multisystem Inflammatory Syndrome in Children (MIS-C) within 1 working day.
3.2.6 HIV/AIDS Reporting
HIV/AIDS reporting is different from methods used to report other diseases. Please go to the HIV-AIDS Page for more information.
3.2.7 Pediatric Acute Hep of Unknown Etiology
CDPH requests that clinicians report cases of children meeting the following working case definition to their LHD’s communicable disease control program within one business day. Report to Fresno County Public Health via phone (559) 600-3200, or fax (559) 600-7607 within one business day
Health Advisory: Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology April 21, 2022 (PDF, 1MB)(PDF, 314KB)
3.2.8 Animal Bite Reporting
- To Report an animal bite or contact with a bat, please use the following electronic bite report form: Electronic Rabies Bite Report Form
- Per Title 17 California Code of Regulations - code 2606 paragraph (a) Reporting, the Local Health Department shall also be notified when any person is bitten by an animal of a species subject to rabies, whether or not the animal is suspected of having rabies.
- ALL ANIMAL BITES to people are legally reportable and should be reported immediately upon discovery.
- Note that bat bites can be too small to detect. All bat-human or bat-domestic animal interactions should be reported immediately.
- AVOID any contact with dead bats. Use the bite report form linked below to report a bat for collection and do not touch the bat
3.2.9 Pesticide-related Illness or Injury Reporting
- Any known or suspected pesticide-related illness or injury must be reported within 24 hours. For more information on reporting please refer to the guidance letter from the Office of Environmental Health Hazard Assessment (OEHHA).
- Call a Poison Control Center to report a case as well as seek advice from them for treating and managing a possible pesticide illness or injury. The Poison Control contact number for health care providers is 1-800-411-8080.
- Pesticide Illness Reporting (PIR) forms are available for download on the OEHHA webpage.
- Failure to report is a citable offense and subject to civil penalty ($250) (Health and Safety Code §105200).
3.2.10 Immunization Data Reporting
Assembly Bill 1797 requires all healthcare providers to submit immunization data to California’s Immunization Registry. Click here to view the associated advisory(PDF, 195KB) and additional information.
4.Additional Information on Reporting and Completing CMRs