Full matrix in PDF format available here.
Code |
Disease |
(1) |
-- |
Acquired Immunodeficiency Syndrome (AIDS) | 3 |
2 |
Anthrax (Bacillus anthracis) | 1 |
5 |
Botulism-Foodborne (Clostridium botulinum) | 1 |
3 |
Botulism-Infant (Clostridium botulinum) | 2 |
4 |
Botulism-Wound (Clostridium botulinum) | 1 |
6 |
Brucellosis (Brucella species) | 2 |
7 |
Campylobacteriosis (Campylobacter species) | 2 |
69 |
Chancroid | 2 |
55 |
Chlamydia trachomatis-Genital | 2 |
57 |
Chlamydia trachomatis-Other | 2 |
56 |
Chlamydia trachomatis-PID | 2 |
9 |
Cholera (Vibrio cholerae) | 2 |
10 |
Congenital Rubella Syndrome | 1 |
1 |
Cryptosporidiosis (Cryptosporidium species) | 2 |
106 |
Cyclospora | 2 |
11 |
Diptheria (Corynebacterium diptheriae) | 1 |
-- |
Disease Outbreaks: all other diseases | 1 |
-- |
Disease Outbreaks: foodborne | 1 |
-- |
Disease Outbreaks: waterborne | 1 |
121 |
Encephalitis, Arboviral: California/LaCrosse Serogroup | 1 |
122 |
Encephalitis, Arboviral: Eastern Equine | 1 |
123 |
Encephalitis, Arboviral: St. Louis | 1 |
108 |
Encephalitis, Arboviral: Venezualan Equine | 1 |
124 |
Encephalitis, Arboviral: Western Equine | 1 |
116 |
Erlichiosis-HGE (Anaplasma phagocytophilum) | 2 |
51 |
Erlichiosis-HME (Ehrlichia chaffeensis) | 2 |
117 |
Erlichiosis-Other | 2 |
52 |
Escherichia coli O157 | 2 |
15 |
Giardiasis (acute) | 2 |
60 |
Gonorrhea-Genital (Neisseria gonorrhoeae) | 2 |
64 |
Gonorrhea-Opthalmic (Neisseria gonorrhoeae) | 2 |
61 |
Gonorrhea-Oral (Neisseria gonorrhoeae) | 2 |
63 |
Gonorrhea-PID (Neisseria gonorrhoeae) | 2 |
62 |
Gonorrhea-Rectal (Neisseria gonorrhoeae) | 2 |
53 |
Group A Streptococcal Invasive Disease (Streptococcus pyogenes) | 1 |
47 |
Group B Streptococcal Invasive Disease (Streptococcus agalactiae) | 1 |
133 |
Guillain-Barre´ Syndrome | 2 |
54 |
Haemophilus influenzae Invasive Disease | 1 |
23 |
Hantavirus Disease | 1 |
58 |
Hemolytic Uremic Syndrome (HUS) | 2 |
480 |
Hepatitis, Viral-HBsAg positive infant | 2 |
48 |
Hepatitis, Viral-HBsAg positive pregnant female | 2 |
16 |
Hepatitis, Viral-Type A acute | 1 |
17 |
Hepatitis, Viral-Type B acute | 2 |
18 |
Hepatitis, Viral-Type C acute | 2 |
-- |
Human Immunodefiency Virus (HIV) | 3 |
20 |
Influenza-number of cases | 2 |
-- |
Lead Levels (blood) | 4 |
21 |
Legionellosis (Legionella species) | 2 |
22 |
Leprosy (Hansen Disease) (Mycobacterium leprae) | 2 |
94 |
Listeriosis (Listeria species) | 1 |
24 |
Lyme Disease | 2 |
25 |
Malaria (Plasmodium species) | 2 |
96 |
Measles-Imported | 1 |
26 |
Measles-Indigenous | 1 |
102 |
Meningitis-Other Bacterial | 1 |
95 |
Meningococcal Disease (Neisseria meningitidis) | 1 |
31 |
Mumps | 1 |
32 |
Pertussis (Whooping Cough) | 1 |
33 |
Plague (Yersinia pestis) | 1 |
35 |
Poliomyelitis-Nonparalytic | 1 |
34 |
Poliomyelitis-Paralytic | 1 |
118 |
Prion disease-Creutzfeldt Jakob Disease | 1 |
119 |
Prion disease-variant Creutzfeldt Jakob Disease | 1 |
36 |
Psittacosis (Chlamydia psittaci) | 2 |
109 |
Q Fever (Coxiella burnetii) | 1 |
105 |
Rabies: Animal | 2 |
37 |
Rabies: Human | 1 |
112 |
Ricin Poisoning | 1 |
39 |
Rocky Mountain Spotted Fever (Rickettsia rickettsii) | 2 |
40 |
Rubella | 1 |
42 |
Salmonellosis: Other than S. Typhi (Salmonella species) | 2 |
41 |
Salmonellosis: Typhoid Fever (Salmonella Typhi) | 1 |
132 |
Severe Acute Respiratory Syndrome (SARS) | 1 |
115 |
Shiga-like toxin positive stool | 2 |
43 |
Shigellosis (Shigella species) | 2 |
107 |
Smallpox | 1 |
110 |
Staphylococcal Enterotoxin B (SEB) Pulmonary Poisoning | 1 |
130 |
Staphylococcus aureus: Menticillin resistant Invasive Disease | 2 |
131 |
Staphylococcus aureus: Vancomycin non-sensitive – all forms | 1 |
50 |
Streptococcus pneumoniae Invasive Disease: Penicillin resistant | 2 |
49 |
Streptococcus pneumoniae Invasive Disease: Penicillin sensitive | 2 |
74 |
Syphilis (Treponema pallidum): Cardiovascular | 2 |
75 |
Syphilis (Treponema pallidum): Congenital | 2 |
72 |
Syphilis (Treponema pallidum): Early Latent | 2 |
73 |
Syphilis (Treponema pallidum): Late Latent | 2 |
77 |
Syphilis (Treponema pallidum): Late Other | 2 |
76 |
Syphilis (Treponema pallidum): Neurological | 2 |
70 |
Syphilis (Treponema pallidum): Primary | 2 |
71 |
Syphilis (Treponema pallidum): Secondary | 2 |
78 |
Syphilis (Treponema pallidum): Unknown Latent | 2 |
44 |
Tetanus (Clostridium tetani) | 2 |
45 |
Toxic Shock Syndrome: Staphylococcal | 2 |
97 |
Toxic Shock Syndrome: Streptococcal | 2 |
46 |
Trichinosis | 2 |
-- |
Tuberculosis, all forms (Mycobacterium species) | 1 |
113 |
Tularemia (Francisella tularensis) | 1 |
101 |
Vancomycin Resistant Enterocci (VRE) Invasive Disease | 2 |
114 |
Varicella deaths | 2 |
104 |
Vibrio infections (Vibrio species) | 2 |
111 |
Viral Hemorrhagic Fever | 1 |
125 |
West Nile virus infections-Encephalitis | 1 |
126 |
West Nile virus infections-Fever | 1 |
98 |
Yellow Fever | 2 |
103 |
Yersiniosis (Yersinia species) | 2 |
(1)Category 1 diseases require immediate telephonic notification, followed by a written report using the PH-1600. Category 2 diseases only require a written report using the PH-1600. Category 3 diseases require special confidential reporting to desgnated health department personnel. For Category 4, laboratories and physicians are required to report all blood lead test results (≥10 µg/dl). |
||
| Revised 09 Nov 09 | ||
The Notifiable Disease Report Form (PH-1600) is available as a Microsoft® Word document that can be saved to your computer and emailed to your Regional Office. It is also available as an Adobe® Acrobat® PDF file that can be printed.
HIPAA Disclaimer for the PH-1600 Form
This form can be used to prepare reports of notifiable disease cases and transmitted to the Tennessee Department of Health in several ways: When printed, the form can be physically delivered or faxed, copied onto magnetic media and physically delivered, or sent electronically, with the appropriate safeguards.
This form contains information that is Protected Health Information as defined by the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and, when prepared by a HIPAA Covered Entity, should be prepared, processed, stored, and transmitted with appropriate safeguards against unlawful disclosure.
Specifically, this form should not be sent by electronic mail unless a) the need to transmit is so urgent, and infrequent, that the Covered Entity's Privacy Officer has determined that the risk of disclosure is acceptable, considering the value of rapid transmission or b) the electronic transmission is made using a form of encryption or otherwise secure manner.
The Tennessee Department of Health (TDH) will provide assistance in establishing secure transmission methods and is willing to accept encrypted, password protected attachments to email with pre-arranged or telephonic transmission of the password. Products in use by the Tennessee Department of Health are Pkware® PKZip® and Adobe® Acrobat®; others may be acceptable with prior arrangements. Contact the Communicable and Environmental Disease Section of the Bureau of Health Services for more information.
Instructions on using the form:
Case Definitions for Nationally Notifiable Infectious Diseases
(Click on the above link to review the document on the Federal HHS web site.)
In the United States, requirements for reporting diseases are mandated by state laws or regulations, and the list of reportable diseases in each state differs. In October 1990, in collaboration with the Council of State and Territorial Epidemiologists, CDC published Case Definitions for Public Health Surveillance (MMWR 1990;39(No.RR-13)[No. RR-13]), which, for the first time, provided uniform criteria for reporting cases.
This report was recently revised and provides updated uniform criteria for state health department personnel to use when reporting to CDC notifiable infectious diseases (Case Definitions for Infectious Conditions Under Public Health Surveillance (MMWR 1997;46[No. RR-10]). A revision date is listed for each case definition that has been revised. Newly generated case definitions that have not been published previously are designated as "adopted" on the specified date.
The MMWR series of publications is published by the Epidemiology Program Office, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia 30333.