Disease Control & Prevention - Communicable Disease Reporting Form

Report Conditions here for Communicable Disease Staff Review

This form can be used to report suspected communicable disease outbreaks and notifiable conditions to Thurston County Public Health and Social Services Disease Control and Prevention - Communicable Disease Staff.

Facilities and Providers please report immediately notifiable conditions to 360-867-2610 during business hours (Monday-Friday 8am-5pm excluding holidays). 24-hour notifiable conditions can be reported by phone to our main Public Health Communicable Disease line at 360-786-5470 during business hours. Leave a message on the answering machine and you will receive a call back. The final opportunity for individuals to leave a message is 5 p.m. on Friday and the open business day preceding any holidays. To report an immediately notifiable condition or 24 hour notifiable condition after hours please call 1-800-986-9050.

For technical assistance or urgent questions please call the Thurston County Public Health and Social Services Communicable Disease Information Line (Monday-Friday) 8:00 AM - 5:00 PM at 360-867-2610. If no one is available with Thurston County Public Health and Social Services and the condition is immediately notifiable or public health emergency please call 1-877-539-4344.

Who are you reporting for? *

I am reporting for myself or a family member

I am reporting for a facility or provider

Contact Information

Leaving contact information is optional. Individuals can expect a response back from the Communicable Disease Team within 2-3 business days.

Do you live in Thurston County? *

Yes

First Name *

Last Name

City

Zip Code

Phone Number *

Email Address

Facility Contact Information & Description

Facility Name *

Street Address

City & Zip Code

Point of Contact for Facility (Full Name) *

Point of Contact Title

Contact Phone Number *

Contact Email Address *

Event Summary

Reporting online does not replace calling in an immediately notiﬁable condition or 24 hour notifiable condition. Report immediately notifiable conditions to 360-867-2610 during business hours (Monday-Friday 8am-5pm excluding holidays). 24-hour notifiable conditions can be reported by phone to our main Public Health Communicable Disease line at 360-786-5470. Leave a message on the answering machine and you will receive a call back. The final opportunity for individuals to leave a message is 5 p.m. on Friday and the open business day preceding any holidays.

For immediately notifiable and 24-hour reportable conditions or a public health emergency needing to be reported AFTER BUSINESS HOURS (Monday-Friday 8:00am-5:00pm) please call 1-800- 986-9050, if no one is available call: 1-877-539-4344.

In Washington State, health care providers, health care facilities, laboratories, veterinarians, food service establishments, child daycare facilities, and schools are legally required to notify public health authorities at their local health jurisdiction of suspected or confirmed cases of selected diseases or conditions. These are referred to as notifiable conditions.

List of Notifiable Conditions | Washington State Department of Health

Notifiable Conditions and the Healthcare Providers and Facilites Poster (WA DOH)

Notifiable Conditions and the Clinical Laboratory (WA DOH)

Patient Information

Please fax (secure eFax: 1-833-418-1916) or attach via secure reporting portal below all relevant medical records, lab reports, patient's demographics, and notes related to the reported event. A member of our team may follow up with you for more information, please ensure contact information provided is accurate.

Patient Full Name

Patient Date of Birth

Patient Address

Patient Phone Number

Event Summary

Condition (if known)

If reporting a sexually transmitted infection, please use the following confidential sexually transmitted infection case report (WA DOH)

Date of symptom onset * +

Please describe observed symptoms:

Please provide an in-depth summary detail regarding the illness diagnosis. (ex: number of cases, total population within facility, diagnostics done so far, trends noted)

Describe any urgent needs required from Thurston County Public Health and Social Services. (ex: education, mitigation guidance, infection control measures, testing, personal protective equipment, etc).

Would you like a line list template provided to you to begin tracking cases? *

I would like to request a line list template.

I do not need a line list template at this time.

Upload an existing line list

Additional File Upload

Additional Details

Add any notes or comments to Thurston County Public Health and Social Services.

412 Lilly Rd. N.E., Olympia, Washington 98506-5132

(360) 867-2610 FAX (833) 499-1806 TDD (360) 867-2603 TDD (800) 658-6384