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Mandatory Report of Communicable Diseases in Michigan

NOTIFY THE HEALTH DEPARTMENT WITHIN 24 HOURS OF ALL REPORTABLE DISEASES.
This reporting is expressly allowed under HIPAA and required by Michigan Public Act 368 of 1978, 333.5111

Click here to view reportable diseases in Michigan by Condition.

Click here to view reportable diseases in Michigan by Pathogen.

1. Please select who you are as a reporter:

Please enter an 'other' value for this selection.

2. Your Name: *This question is required.

3. Your Phone Number: (Enter numbers only) *This question is required. This question requires a valid number format.

4. Practice Name and Location

Practice Name
Address Line 1
Address Line 2
City
ZIP Code

5. Patient's Full Name: *This question is required.

6. Parent/Guardian's Name (if patient is a minor):

7. Patient's Date of Birth: *This question is required. This question requires a valid date format of MM/DD/YYYY.

calendar

8. Patient's Sex: *This question is required.

9. Patient's Race:

10. Patient's Phone Number: (Enter numbers only) *This question is required. This question requires a valid number format.

11. Patient's Street Address - Please include street number, street name, city, and ZIP code:

12. Choose Reportable Disease: *This question is required.

13. Has the patient been notified of the diagnosis? *This question is required.

We generally receive a better response from patients if they have been informed by their physician of their diagnosis before we contact them. We would appreciate it if you could call them and let them know the Health Department will be calling them in the next day or two. Thank you!