Disease Report Forms
These forms are used to report disease cases to the Imperial County Public Health Department. For more information, call (442) 265-1464 or send an email 24/7 to phepireport@co.imperial.ca.us
This form must be completed and submitted to the Imperial County Public Health Department to request testing at a Public Health Laboratory for suspect human cases of 2019 Novel Coronavirus (COVID-19).
An Animal Bite Report form is used to document incidents of animal bites, providing essential information for tracking and managing potential health risks, including the transmission of diseases like rabies, and aiding in follow-up medical care and public health interventions.
This form is used to collect and report specific information about certain communicable diseases to public health authorities, ensuring accurate tracking, monitoring, and appropriate response to potential health threats while maintaining patient confidentiality.
- Confidential Morbidity Report (Report all conditions except TB)
- Confidential Morbidity Report for TB only (Report Tuberculosis)
- Confidential Morbidity Report for COVID-19
- Confidential Morbidity Report for DMV (Report conditions that impair consciousness or control)
- Confidential Morbidity Report for Animals
Imperial County Public Health Department participates in the California Gonorrhea Surveillance System (CGSS), which was developed in response to the need for detailed risk behavior data and clinical data required to control increasing gonorrhea infections in California. CGSS is a sample-based surveillance system implemented throughout California in 2007.
In 34 of 61 local health jurisdictions, 10% of gonorrhea cases are sampled for interview; in the other 27 health departments, including Imperial County, all cases are followed. A standardized case investigation record collects case-reported risk data and provider-reported clinical data.
Health-care providers who diagnose gonorrhea cases are asked to complete and fax a one-page Provider Report Form to the Public Health Department. This is page two of the Gonorrhea Case Investigation Record. The Confidential Fax number is (442) 265-1477. Public Health investigators follow up with the cases to collect additional risk information.
This report provides information on the number of cases reported for selected communicable diseases in Imperial County.