North Dakota Morbidity Report

North Dakota Department of Health
Division of Disease Control
Confidentiality Protected by North Dakota Century Codes 23-07-02.1 and 23-07-02.2

*North Dakota Department of Health will follow up on incomplete reports as needed.

Morbidity Report Card is only for reporting of clinically verified tests, do not report in-home tests as an individual

Select Condition

Disease or Condition

Select Disease or Condition Acute Flaccid Myelitis Anaplasmosis Anthrax Arboviral Infection Autism Babesiosis Botulism Brucellosis Campylobacteriosis Cancer Candida auris Carbapenem - resistant Enterobacteriaceae (CRE) Carbapenem-resistant Pseudomonas aeruginosa CD4 Test Results Chickenpox (varicella) Chikungunya virus disease Chlamydial infection Cholera Cluster of severe or unexplained illnesses and deaths Coccidiomycosis Coronavirus Novel COVID Creutzfeldt - Jakob disease Critical Congenital heart disease Cryptosporidiosis Cyclosporiasis Dengue Diphtheria E. coli (Shiga-toxin producing strains) Eastern equine enecphalitits Ehrlichiosis Fetal Alcohol syndrome (FAS) Foodborne-waterborne outbreak Giardiasis Glanders Gonorrhea Haemophilus influenzae (invasive) Hantavirus Hemolytic uremic syndrome Hepatitis (Non-specified) Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E HIV infection/AIDS Influenza Jamestown Canyon virus disease Klebsiella pneumoniae carbapenemase (KPC) - producers La Crosse Encephalitits Lab incidents with possible Category A Agents or novel influenza Lead (all) Legionellosis Leptospirosis Listeriosis Lyme disease Malaria Measles (rubeola) Melioidosis Meningococcal disease (invasive) Mumps Neonatal abstinence syndrome (NAS) Nipah virus infections Nosocomial outbreak Novel Severe Acute Respiratory Illness Other (if other specify in comments) Overdoses Pertussis Plague Poliomyelitis Powassan virus disease Pregnancy in person infected with perinatally transmissible disease (such as hepatitis B and HIV) Q fever Rabies (animal) Rabies (human) Rocky Mountain spotted fever Rubella Salmonellosis Scabies outbreak in institutions Shigellosis Smallpox St. Louis encephalitis Staphylococcus aureus (vancomycin-resistant)-VRSA Staphylococcus enterotoxin B intoxication Streptococcus pneumoniae (invasive) Streptococcus pneumoniae drug resistant (invasive) Suicide and suicide attempts Syphilis Tetanus Tickborne disease Trichinosis Tuberculosis - Active Tuberculosis - Latent Tularemia Tumors of the central nervous system Tumors of the central nervous system Typhoid fever Unexplained or emerging critical illness/death Unusual disease cluster Vibriosis Violent Deaths Viral hemorrhagic fevers Visible congenital deformity Weapons of mass destruction or suspected event West Nile Virus Western equine enecphalitis Yellow Fever Zika Virus

Date of Onset

Patient Information

Last Name		First Name		Gender	Male Female Unknown
Street Address
City		State AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	Zip Code	County	Unknown Adams Barnes Benson Billings Bottineau Bowman Burke Burleigh Cass Cavalier Dickey Divide Dunn Eddy Emmons Foster Golden Valley Grand Forks Grant Griggs Hettinger Kidder LaMoure Logan McHenry McIntosh McKenzie McLean Mercer Morton Mountrail Nelson Oliver Pembina Pierce Ramsey Ransom Renville Richland Rolette Sargent Sheridan Sioux Slope Stark Steele Stutsman Towner Traill Walsh Ward Wells Williams
Telephone No.
Date of Birth		Race	American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Unknown	Ethnicity	Hispanic Non-Hispanic Unknown
Name of Employer		Business Telephone		Marital Status	Married Single Unknown

>Clinical Information

Was Patient Hospitalized?	No Yes Unknown	Is Case Pregnant?   Unknown Pregnant Not Pregnant Not Applicable	Outcome	Survived Died
Date Admitted		Date Discharged
Name of Hospital		Health Care Provider
Was Person Treated?	Yes No Unknown Not Applicable	Treatment Date
Treatment

Lab Information

Other Information