Vaccines and immunization
- 0-18 Report of Immunization form (PDF, 1 page, 102 KB)
- Report of Adverse Event Following Immunization (AEFI) (PDF, 1 page, 180 KB)
- Medical Exemption Form
- School Based Vaccine Request Form (Hep B, Menactra, and HPV) (PDF, 1 page, 755 KB)
- Vaccine Order Form (PDF, 1 page, 724 KB)
- Vaccine Return Form (PDF, 1 page, 439 KB)
- Vaccine Temperature Log Book (PDF, 26 pages, 3 MB)
Infectious diseases
- Infectious Disease Risk Assessment Form for Emergency Services Workers (PDF, 6 pages, 657 KB)
- Confidential Hepatitis B Questionnaire (PDF, 2 pages, 1.7 MB)
- Follow-up Reporting Form for Infants Born to Hepatitis B+ Mothers (PDF, 1 page, 193 KB)
- Hepatitis PCR Requisition: Hepatitis C RNA and/or Hepatitis B DNA Viral Load (PDF, 3 pages, 187 KB)
- Confidential Hepatitis C Questionnaire (PDF, 2 pages, 196 KB)
- Rabies Exposure Report (PDF, 1 page, 168 KB)
- Rabies Vaccine & Immune Globulin: Patient Vaccination Schedule (PDF, 1 page, 70KB)
- Reporting Mantoux TB Skin Test Form (PDF, 1 page, 341 KB)
Mandatory Blood Testing Act (MBTA)
Fax applications to our secure Reportable Diseases fax line: 1-855-WDG-LINE (1-855-934-5463).
Outbreaks
- Daily Outbreak Line Listing Fax Cover Sheet (PDF, 1 page, 104 KB)
- Enteric Outbreak Line Listing (PDF, 1 page, 140 KB)
- Respiratory Outbreak Line Listing (PDF, 1 page, 827 KB)
- Thermometer Order Form (PDF, 1 page, 132 KB)
- Vaccine Order Form (PDF, 1 page, 724 KB)
- Vaccine Return Form (PDF, 1 page, 439 KB)
Sexually transmitted infections (STIs)
- Chlamydia Treatment Request for Information Fax Sheet (PDF, 1 page, 101 KB)
- Gonorrhea Treatment Request for Information Fax Sheet (PDF, 1 page, 101 KB)
- Confidential Hepatitis B Questionnaire (PDF, 2 pages, 1.7 MB)
- Follow-up Reporting Form for Infants Born to Hepatitis B+ Mothers (PDF, 1 page, 189 KB)
- STI (Sexually Transmitted Infection) Medication Order Form (PDF, 1 page, 91 KB)
- STI (Sexually Transmitted Infection) Medication Log (PDF, 1 page, 76 KB)
- Syphilis Treatment Letter (PDF, 2 pages, 126 KB)