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Communicable Disease Reporting Form

Use this form to report a communicable disease (except HIV/AIDS).

  • Submit one form for each disease you are reporting. 
  • This form is secure and HIPAA-compliant.  
  • Do not report HIV/AIDS with this form. Instead please use this reporting form (PDF) and, if needed, form instructions (PDF). 
  • Schools and childcare facilities do NOT need to report individual cases of COVID-19, influenza, or norovirus.
  • If you have additional questions or concerns, call the Washtenaw County Health Department at 734-544-6700 or email health@washtenaw.org.
This question requires a valid date format of MM/DD/YYYY.
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2. Select the communicable disease you are reporting *This question is required.
3. Type of influenza
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