Required Reporting to Public Health

For diseases and conditions required to be reported within 24 hours, the initial report shall be made by telephone to the local health department, and the written disease report be made within 7 days.

The reportable disease timeframe can be accessed here.

You may be contacted by the local health department for additional information about this case. Medical record information relevant to the investigation and/or control of a communicable disease is exempt from the HIPAA Privacy Rule (see 45 CFR 164.512(a) ) and is permitted as an exception to confidentiality of records in NC State Law GS § 130 A-130.

North Carolina General Statute: §130A-135. Physicians to report.
A physician licensed to practice medicine who has reason to suspect that a person about whom the physician has been consulted professionally has a communicable disease or communicable condition declared by the Commission to be reported, shall report information required by the Commission to the local health director of the county or district in which the physician is consulted.

North Carolina Administrative Code: 10A NCAC 41A.0101 Reportable Diseases and Conditions
(a) The following named diseases and conditions are declared to be dangerous to the public health and are hereby made reportable within the time period specified after the disease or condition is reasonably suspected to exist:

Reporting Physician/Practice

After the tenth phone digit, any additonal digits will format as extension: x99

Patient Information

Patient Contact

Patient is Unsheltered/Homeless (if checked Address fields not required)
After the tenth phone digit, any additonal digits will format as extension: x99

Emergency Contact

After the tenth phone digit, any additonal digits will format as extension: x99

Demographics

Sex

Race select all that apply

Patient Associations select all that apply

Disease/Condition Information

Symptoms

(Required if Symptomatic=Yes)
(Required if Symptomatic=Yes)

Exposure Location

Outcome

Treatment Details (REQUIRED for Sexually Transmitted Diseases)

Treatment Date Medication Dosage Duration
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Diagnostic Testing

If diagnostic testing not completed (provider diagnosed), leave section blank and attach office visit notes.
If unable to attach lab results, complete section below and fax lab results to (828)250-6169
Specimen Date Specimen Number Specimen Source Type of Test Test Result(s) Description Result Date Lab Name - City/State
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Attach Copy of Lab Results/Other Pertinent Records

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