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507.3E2 REPORTABLE INFECTIOUS DISEASES

  Code No. 507.3E2

 

REPORTABLE INFECTIOUS DISEASES

 

 

While the school district is not responsible for reporting, the following infectious diseases are required to be reported to the state and local public health offices:

 

 

Acquired Immune                                 Leprosy                                           Rubella (German

  Deficiency Syndrome                         Leptospirosis                                     measles)

  (AIDS)                                               Lyme disease                                    Rubeola (measles)

Amebiasis                                             Malaria                                            Salmonellosis

Anthrax                                               Meningitis                                        Shigellosis

Botulism                                                (bacterial or viral)                          Tetanus

Brucellosis                                            Mumps                                             Toxic Shock Syndrome

Campylobacteriosis                              Parvovirus B 19                               Trichinosis

Chlamydia trachomatis                          infection (fifth                               Tuberculosis

Cholera                                                  disease and other                            Tularemia

Diphtheria                                             complications)                               Typhoid fever

E. Coli 0157:h7                                   Pertussis                                           Typhus fever

Encephalitis                                           (whooping cough)                          Venereal disease

Giardiasis                                              Plague                                                Chancroid

Hepatitis, viral                                     Poliomyelitis                                     Gonorrhea

  (A,B, Non A-                                     Psittacosis                                          Granuloma Inguinale

  Non-B, Unspecified)                          Rabies                                                Lymphogranuloma

Histoplasmosis                                     Reye's Syndrome                                   Venereum

Human Immunodeficiency                   Rheumatic fever                                 Syphilis

  Virus (HIV) infection                         Rocky Mountain                              Yellow fever

  other than AIDS                                  spotted fever

Influenza                                              Rubella (congenital

Legionellosis                                          syndrome)

 

                                                           

Any other disease which is unusual in incidence, occurs in unusual numbers of circumstances, or appears to be of public health concern, e.g., epidemic diarrhea, food or waterborne outbreaks, acute respiratory illness.

 

 

 

 

  Code No. 507.3E3

REPORTING FORM

 

Source:  Iowa Department of Public Health (1997).

REPORT THE FOLLOWING DISEASES IMMEDIATELY BY TELEPHONE (1-800-362-2736)

Botulism

Poliomyelitis

Yellow Fever

Cholera

Rabies (Human)

Disease outbreaks of

Diphtheria

Rubella

       any public health concern

Plague

Rubeola (measles)

 

REPORT ALL OTHER DISEASES BELOW.

WEEK ENDING

 

See other side for list of reportable infectious diseases.

 

DISEASE

 

PATIENT

COUNTY OR CITY

 

DOB

 

SEX

 

Name                                                                       Parent (If applicable)

 

 

 

 

Address

 

Attending Physician

 

 

Name                                                                       Parent (If applicable)

 

 

 

 

Address

 

Attending Physician

 

 

Name                                                                       Parent (If applicable)

 

 

 

 

Address

 

Attending Physician

 

 

Name                                                                       Parent (If applicable)

 

 

 

 

Address

 

Attending Physician

 

 

Name                                                                       Parent (If applicable)

 

 

 

 

Address

 

Attending Physician

 

                 

 

Reporting Physician, Hospital, or Other Authorized Person

 

Address

 

Remarks:

 

 

FOR SCHOOLS ONLY:  Report over 10% absent only.  Total enrollment:                                               

 

Monday

Tuesday

Wednesday

Thursday

Friday

No.

Absent

 

 

 

 

 

% of Enrollment

 

 

 

 

 

REPORT NUMBER OF CASES ONLY

 

                                    Chickenpox                                                                                                           Gastroenteritis

                                    Erythema infectiosum (5th Disease                                                                      Influenza-like illness (URI)