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Disease/Condition Specific Case Report Forms

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exclamation point= Report immediately upon initial suspicion or laboratory test order, 24/7 by phone
telephone= Report immediately, upon diagnosis or test result, 24/7 by phone
Available 24 hours a day, 7 days a week at our main number (850) 245-4401
 

A - B - C - D - E - F - G - H - I - J - K - L - M - N - O - P - Q - R -S - T - U - V - W - X - Y - Z


Florida Surveillance Case Definitions
(02/13)
Interim Guidance for Non-Culture Results for Select Enteric Diseases (07/11 v1.0)
Recommendations for Interview and Investigation of Reported Cases of Enteric Infections (03/12)
Reportable Diseases/Conditions in Florida (11/08)
Fungal Meningitis Reporting Guidance  (10/12 v1.0)
Meningitis Outbreak Following Epidural Steroid Injection Case Report Form (10/12 v1.0)

Basic Case Investigation Form (Merlin Electronic Submission, v3.2 rev.03/12)
Disease Control Measures (08/11)
Interstate Reciprocal Notification of Disease (CDC 42.1(E), rev.12/02)
Product Complaint Form (DH 4072, 11/98)
Practitioner Disease Report Form (DH 2136, 7/09)
 

Condition

Case Definition
(FL Disease Code)

Guide to Surveillance Investigations (GSI)

Case Report Form (CRF)

CRF
Submission

Amebic Encephalitis 13620 GSI
rev. 09/12		 CRF
rev. 12/10		 Paper CRF Required
exclamation pointAnthrax 02200     Contact BOE
Arsenic Poisoning 98080 GSI
rev. 12/11		 CRF
rev. 09/08		 Paper CRF Required
B

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exclamation pointBotulism Foodborne - 00510   CRF
rev. 04/83		 Paper CRF Required
Infant - 00511
Other - 00512
Wound - 00513
exclamation pointBrucellosis 02300 GSI
rev. 09/12

More...

 CRF
rev. 09/11		 Merlin Extended Data
C

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California serogroup neuroinvasive
06250		 GSI

More...

 CRF
rev. 08/08		 Merlin Extended Data
non-neuroinvasive
06251
Campylobacteriosis 03840 GSI
rev. 08/12

More...

   No CRF Required
Carbon Monoxide Poisoning 98600 GSI
rev. 12/11		 CRF
rev. 08/11		 Merlin Extended Data
exclamation pointCholera, Vibrio 00190 GSI
rev. 12/11

More...		 CRF
rev. 07/00		 Paper CRF Required; Merlin Outbreak Module
Ciguatera Poisoning 98809 GSI
rev. 12/11		 CRF
rev. 03/13		 Merlin Extended Data
Creutzfeldt-Jakob Disease (CJD) 04610 GSI
rev. 10/11		 CRF
rev. 2006		 Paper CRF Required
Cryptosporidiosis 13680 GSI
rev. 08/12

More...

 CRF No CRF Required
Cyclosporiasis 00720 GSI
rev. 12/11		 CRF
rev. 09/10		 Merlin Extended Data
D

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Dengue Fever 06100 GSI

More...		 CRF
rev. 08/08		 Merlin Extended Data
exclamation pointDiphtheria 03290 GSI
rev. 08/12		 CRF
rev. 05/98		 Paper CRF Required
E - F

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Eastern Equine Encephalitis neuroinvasive
06220		 GSI

More...		 CRF
rev. 08/08		 Merlin Extended Data
non-neuroinvasive
06221
Ehrlichiosis/Anaplasmosis, Human 08381 GSI
rev. 08/12		 CRF
rev. 01/08		 Paper CRF Required
Encephalitis, Other (non-arboviral) 03236 More... CRF
rev. 08/08		 No CRF Required
Enteric Disease, Unspecified   More... CRF  
telephoneEscherichia coli, Shiga Toxin-Producing (STEC) 00800 GSI
rev. 09/12

More...

 CRF
rev. 03/12		 Merlin Extended Data
Foodborne, Outbreak   More... CRF
rev. 03/08		  
G

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Giardiasis 00710 GSI
rev. 09/12

More...

   No CRF Required
exclamation pointGlanders (Burkholderia mallei) 02400     No CRF Required
H

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  Haemophilus influenzae (Invasive Disease) 03841 GSI
rev. 01/13		 CRF
rev. 12/07		 Merlin Extended Data
Hansen's Disease (Leprosy) 03090   CRF
rev. 06/93		 Paper CRF Required
telephoneHantavirus Infection (Hantavirus Pulmonary Syndrome) 07869   CRF
rev. 06/98		 Paper CRF Required
telephoneHemolytic Uremic Syndrome (HUS) 42000 See Escherichia coli, Shiga Toxin-Producing (STEC)   No CRF Required
telephoneHepatitis A 07010 GSI
rev. 08/12		 CRF
rev. 08/01		 Merlin Extended Data
Hepatitis B Acute - 07030   CRF
rev. 08/01		 Merlin Extended Data
Chronic - 07032 GSI
rev. 08/12
Perinatal - 07744  
Hepatitis B Surface Antigen (HBsAg+), in Pregnant Women 07039   CRF
rev. 08/01		 Merlin Extended Data
Hepatitis C Acute - 07051   CRF
rev. 08/01		 Merlin Extended Data
Chronic - 07054
Chronic in Young Adults - 07054 CRF
rev. 05/12
Hepatitis D 07052 GSI
rev. 01/13		 CRF
rev. 08/01		 Merlin Extended Data
Hepatitis E 07053   CRF
rev. 08/01		 Merlin Extended Data
Hepatitis G 07059   CRF
rev. 08/01		 Merlin Extended Data
I

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exclamation pointInfluenza A, Novel or Pandemic Strains 48790 More... DOH - Avian
CRF
rev. 06/06		 2011: Contact BOE
CDC - Novel
CRF
rev. 12/11		 2009 H1N1: Merlin Outbreak Module
Pregnant
CRF
rev. 10/09		 2009 H1N1 in Pregnant Women: Paper CRF Required
telephoneInfluenza-Associated Pediatric Mortality 48700   CRF Paper CRF Required
L

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Lead Poisoning 94890 GSI
rev. 12/11		   Merlin Extended Data
Legionellosis 48280 More... CRF
rev. 02/03		 Merlin Extended Data
Leptospirosis 10090   CRF
rev. 12/10		 Paper CRF Required
telephoneListeriosis 02700   CRF
rev. 02/93

Spanish - CRF		 Merlin Extended Data and Paper CRF Required
Lyme Disease 06959   CRF
rev. 02/06		 Merlin Extended Data
M - N

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Malaria 08460 GSI CRF
rev. 01/02		 Merlin Extended Data
Indigenous
CRF
exclamation pointMeasles (Rubeola) 05590 GSI
rev. 08/12		 CRF
rev. 09/87		 Merlin Extended Data
exclamation pointMelioidosis (Burkholderia pseudomallei) 02500     No CRF Required
Meningitis, Bacterial, Cryptococcal, Mycotic 32090   CRF
rev. 12/07		 Merlin Extended Data
exclamation pointMeningococcal Disease 03630 GSI
rev. 08/12		 CRF
rev. 12/07		 Merlin Extended Data
Mercury Poisoning 94899 GSI
rev. 12/11		 CRF
rev. 09/08		 Paper CRF Required
Mumps 07290 GSI
rev. 08/12		   Merlin Extended Data
telephoneNeurotoxic Shellfish Poisoning 98800 GSI
rev. 12/11		   No CRF Required
O - P

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Outbreak Foodborne see foodborne...    
Waterborne see waterborne...
telephonePertussis 03390   CRF
rev. 09/97		 Merlin Extended Data
Pesticide-Related Illness and Injury 09894 GSI
rev. 08/12		 CRF
rev. 07/06		 Merlin Extended Data
exclamation pointPlague 02000   CRF
rev. 02/06		 Contact State Health Office
exclamation pointPoliomyelitis Paralytic - 04590     Contact State Health Office
Non-Paralytic - 04520
Psittacosis 07390   CRF
rev. 01/08		 Paper CRF Required
Q - R

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Q Fever (Coxiella burnetii) Acute - 08301   CRF
rev. 02/08		 Paper CRF Required
Chronic - 08302
exclamation pointRabies Animal - 07102 GSI Animal Bite
CRF
rev. 10/06		 Merlin Extended Data
Human - 07100    
Possible Exposure - 07103 PEP CRF
rev. 11/00		 Merlin Extended Data
exclamation pointtelephoneRicin Toxicity 98830 GSI
rev. 01/13		   No CRF Required
Rocky Mountain Spotted Fever 08200   CRF
rev. 01/08		 Paper CRF Required
exclamation pointtelephoneRubella 05690 GSI
rev.2/13		 CRF
rev. 09/97		 Merlin Extended Data
exclamation pointRubella, Congenital Syndrome 77100

GSI

rev. 2/13

 CRF
rev. 03/97		 Paper CRF Required
S

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Salmonellosis 00300 GSI
rev. 09/12

More...

 CRF
rev. 03/12		 Merlin Extended Data (optional)
Saxitoxin Poisoning (Paralytic Shellfish Poisoning) 98840     No CRF Required
exclamation pointtelephoneSevere Acute Respiratory Syndrome-associated Coronavirus (SARS-CoV) Disease 07982 GSI
rev. 11/12		 CRF
rev. 03/03		 Paper CRF Required
Shigellosis 00490 GSI
rev. 09/12

More...

 CRF
rev. 03/12		 Merlin Extended Data
exclamation pointSmallpox 05090     No CRF Required
St. Louis Encephalitis Neuroinvasive
06230		 GSI

More...		 CRF
rev. 08/08		 Merlin Extended Data
Non-neuroinvasive
06231
Staphylococcus aureus Community-associated Mortality 04111 GSI
rev. 08/12		 CRF
rev. 12/08		 Paper CRF Required
Staphylococcus aureus, Vancomycin Non-susceptible 38100 GSI
rev. 08/12

More...

   Contact BOE
Staphylococcus Enterotoxin B (SEB) 38200     Paper CRF Required
Streptococcal Disease, Invasive, Group A 03400   CRF
rev. 11/00		 Paper CRF Required
Streptococcus pneumoniae, Invasive Disease Susceptible
04830		 GSI
rev. 08/12		 CRF
rev. 06/99		  
Resistant
04823
T

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Tetanus 03700 GSI
rev. 11/12		 CRF
rev. 09/97		 Paper CRF Required
Toxoplasmosis 13090     No CRF Required
Trichinellosis 12400   CRF
rev. 12/10		 Paper CRF Required
exclamation pointTularemia (Francisella tularensis) 02190   CRF
rev. 01/06		 Paper CRF Required
Typhoid Fever 00200   CRF
rev. 03/07		 Paper CRF Required
Typhus Fever, endemic (Rickettsia typhi) 08100     No CRF Required
exclamation pointTyphus Fever, epidemic (Rickettsia prowazekii) 08000     No CRF Required
V - Y

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exclamation pointVaccinia Disease 09990     Contact BOE
Varicella Chickenpox - 05290   CRF
rev. 07/07		 Merlin Extended Data
Mortality - 05290 CRF
rev. 05/05		 Merlin Extended Data and a Paper CRF must be Completed
exclamation pointVenezuelan Equine Encephalitis neuroinvasive
06620		 GSI

More...		 CRF
rev. 08/08		 Merlin Extended Data
non-neuroinvasive
06621
Vibrio, Infections 00193 More... CRF
rev. 07/00		 Merlin Extended Data
exclamation pointViral Hemorrhagic Fever 07889     Contact BOE
Waterborne, Outbreak   More... CRF
rev. 03/08		  
West Nile Virus neuroinvasive
06630		 GSI

More...		 CRF
rev. 08/08		 Merlin Extended Data
non-neuroinvasive
06631
Western Equine Encephalitis neuroinvasive
06210		 GSI

More...		 CRF
rev. 08/08		 Merlin Extended Data
non-neuroinvasive
06211
exclamation pointYellow Fever 06090 GSI CRF
rev. 08/08		 Paper CRF Required

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This page was last modified on: 05/6/2013 10:18:49