State Form 43823 - Confidential Report Of Communicable Diseases Page 2
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2Reportable Diseases (for reporting requirements, see code 410 IAC 1-2.5-75)
Diseases to be reported on THIS form:
Diseases to be reported within 24 hours
Haemophilus influenzae,
invasive disease
Diseases to be reported IMMEDIATELY (upon suspicion)
Mumps
Anthrax
Novel influenza A
Arboviral encephalitis
Pertussis
(Eastern Equine, St. Louis, La Crosse, West Nile,
Diseases to be reported within 72 hours
California, Western Equine, Powassan,
Anaplasmosis
Japanese)
Babesiosis
Botullism
Campylobacteriosis
Brucellosis
Carbapenemase-producing Carbapenem-resistant
Chikungunya virus
Enterobacteriaceae
Cholera
Dengue
Chancroid
Diphtheria
Chlamydia trachomatis
, genital infection
Eastern equine encephalitis
Cryptosporidiosis
Escherichia coli infection
Cyclospora
Hantavirus pulmonary syndrome
Cysticercosis
Hemolytic uremic syndrome
Giardiasis
Hepatitis, viral, Type B, pregnant woman
Gonorrhea
Hepatitis, viral, Type E
Granuloma inguinale
Japanese encephalitis
Hansen’s disease
La Crosse encephalitis
Hepatitis, viral, Type B
Measles
Hepatitis, viral, Type C (acute), within five (5) business days
Meningococcal disease
Hepatitis, viral, Type Delta
Plague
Hepatitis, viral, unspecified
Poliomyelitis
Histoplasmosis
Powassan virus
Q fever
Influenza-associated death (all ages)
Rabies in humans or animals
Legionellosis
Rubella
Leptospirosis
Rubella congenital syndrome
Listeriosis
Shigellosis
Lyme disease
Smallpox
Lymphogranuloma venereum
St. Louis encephalitis
Malaria
Tularemia
Psittacosis
Typhoid
Rabies, postexposure treatment
West Nile virus
Rocky Mountain spotted fever
Western equine encephalitis
Salmonellosis
Yellow fever
Staphylococcus aureus
Streptococcus pneumonia
Streptococcus,
Group A
Syphilis
Diseases reported on a DIFFERENT form
Tetanus
Acquired Immunodeficiency Syndrome
Toxic shock syndrome
Animal Bites
Trichinosis
Human Immunodeficiency Virus Infection
Typhus
Tuberculosis, Cases, Reactors, and Latent Infection
Varicella
Vibriosis
Yersiniosis
For questions or emergencies, call the Epidemiology Resource Center at 317-233-7125.
Please fax completed form to 317-234-2812.
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