DHMH1140 Communicable disease reporting form 2025

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The provider is required by law to report these diseases. By cooperating with state health workers, you can help them locate the source of an infection or prevent the spread of an epidemic.
Maryland law and regulation require reporting of syphilis, gonorrhea, and chlamydia by both laboratories and health care providers.
Health care providers in Maryland are required to report the following STIs to the local health department of the jurisdiction where the patient resides: chancroid, chlamydia, gonorrhea, hepatitis, HIV and syphilis.
Confidential Morbidity Report Form (CMR) The DMV CMR Form is used for reporting lapses of consciousness or control, Alzheimers disease or other conditions which may impair the ability to operate a motor vehicle safely (pursuant to HS 103900).
Diseases reportable to the CDC include: Anthrax. Arboviral diseases (diseases caused by viruses spread by mosquitoes, sandflies, ticks, etc.) such as West Nile virus, eastern and western equine encephalitis. Babesiosis. Botulism. Brucellosis. Campylobacteriosis. Cancer. Candida auris, clinical.
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Information gathered and recorded in association with the care of a patient is confidential. Disclosing information to third parties for commercial purposes without consent undermines trust, violates principles of informed consent and confidentiality, and may harm the integrity of the patient-physician relationship.
Confidential Morbidity Report (CMR) forms for reporting communicable diseases, tuberculosis, loss of consciousness or control, and animal patients are provided below. CMR - COVID-19.

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