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Notifiable Disease and Conditions Reporting Form

TO REPORT A NOTIFIABLE CONDITION
(Click Here for a list of Notifiable Diseases)

Call the 24-HOUR REPORTING HOTLINE
360-414-
5599

Or

FILL OUT THE ENTIRE FORM BELOW and hit the submit button at the bottom of the page.

TO REPORT AN STD, you can also print out    this form, fill it out and fax it to 360-425-7531

WAC 246 101:   (Diseases and conditions notifiable by health care providers in Washington State, effective October 2000 (newly notifiable conditions are indicated by an arrow and bold lettering)  

Washington DOH Notifiable Conditions

Please provide the following contact information:

Name
Title
Organization
Street Address
City
State/Province
Zip/Postal Code
Work Phone
Disease
Address (cont.)
FAX
E-mail
URL

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Notice of Privacy Practices

All information on this website is general in nature and is not intended to be used as a substitute for appropriate professional advice.

Cowlitz County Health Department - 1952 9th Avenue - Longview, WA 98632 - (360)414-5599
Copyright © 1998-2010 Cowlitz County.  All Rights Reserved. Disclaimer and Credits     Feedback/Comments

Last Updated: August 21, 2009