Last Name First Name   Middle Name   Nickname (AKA)   Search on nickname only   Date of Birth (mm/dd/yyyy) / / Sex Choose One Female Male Other Unknown SSN - -

Select the Disease/Diagnosis you are reporting and to the best of your knowledge, the Date of Onset (If you don't know the Date of Onset, please use Lab Date); when finished, click Search. For information on clinical and surveillance case definitions, as well as,laboratory specimens required for diagnosis click here Disease/Diagnosis Choose One Ameb Animal Bite Anthrax Botulism - Food Botulism - Infant Botulism - Other Brucellosis Campylobacteriosis Chancroid Cryptosporidiosis Cyclosporiasis D.Fragilis Dengue Dengue Hem. Fever Diphtheria E.Coli O157:H7 Eastern Equine Encephalitis Infection Ehrlichiosis, Hg Ehrlichiosis, Hm Flu Activity Flu Activity / A Or B Giardiasis Haemophilus Influenzae (Invasive) Hantavirus Hbsag Positive Pregnant Women Hemolytic Uremic Syndrome Hepatitis A (Acute) Hepatitis B (Acute) Hepatitis C Lacrosse Infection Latent TB Infection In Children < 5 Lead Blood Level >= 10ug/Dl Legionellosis Leprosy Leptospirosis Listeriosis (Invasive) Lyme Disease Malaria Measles (Rubeola) Meningitis Mumps Neisseria Meningitidis (Invasive) Newly Identified Hbsag Positive Carriers Pertussis Plague Poliomyelitis Psittacosis Q Fever Rabies (Animal) Rabies (Human) Rheu/Fever Rocky Mountain Spotted Fever Rubella (Including Congenital) S. Aureus With Vancomycin Mic>4 Mcg/Ml Salmonellosis Shiga Toxin Producing E.Coli (Slt) Shigellosis Smallpox St.Louis Encephalitis Infection Streptococcal Disease, Group A (Invasive) Streptococcal Disease, Group B (Invasive) Streptococcus Pneumoniae (Invasive) Tetanus Toxic Shock Syndrome Toxomoplasmosis Trich Tuberculosis Tularemia Typhoid Typhus (Epid/Louse/Flea) Vibrio West Nile Infection Yersinia Date of Onset (mm/dd/yyyy) / /