North Dakota Morbidity Report

North Dakota Department of Health and Human Services
Disease Control and Forensic Pathology
Confidentiality Protected by North Dakota Century Codes 23-07-02.1 and 23-07-02.2
SFN Morbidity Report Card (pdf)

*North Dakota Department of Health and Human Services 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 Date of Onset 

Patient Information

Last Name   First Name   Gender  
Street Address
City   State   Zip Code County  
Telephone No.
Date of Birth     Race Ethnicity
Name of Employer Business Telephone Marital Status

>Clinical Information

Was Patient Hospitalized?Is Case Pregnant?   Outcome
Date Admitted Date Discharged 
Name of HospitalHealth Care Provider
Was Person Treated? Treatment Date  

Lab Information

Other Information

Person Reporting Facility TypeOrdering Facility 
Telephone Number 
Cancer SiteDate Cancer DiagnosedCancer Histology
Symptoms and Comments