Infectious Disease Reporting Form

Infectious Disease Reporting Form

An epidemiologist will review your report within three business days
Salt Lake County Health Department monitors infectious diseases in Salt Lake County only. For patients who live outside Salt Lake County, please contact the appropriate local or county health department.
Your Name

First NameLast Name
Your Clinic or Facility Name (if applicable)
Your Phone Number
So we can follow-up with you, if necessaryFormat: 000-000-0000.
Your Email
example@example.com

Reportable Disease
{reportableDisease} must be reported IMMEDIATELY BY PHONE.

Please call 385-468-8888 and select option 7.
Pertinent Information About the Diagnosis
Please do NOT include patient-identifying information!
Should be Empty: