Maryland Department of Health
Prevention and Health Promotion Administration

​​​​​​​​​​​

Disease / Condition-Specific Forms

Acute Flaccid Myelitis​
​Influenza, Novel 
​Tickborne Rickettsial (RMSF/Ehrlichiosis/Anaplasmosis)
​Anthrax
​Influenza-Associated Pediatric Death
​Toxic Shock Syndrome
​Babesiosis​​
​Kawasaki Syndrome
Trichinosis
​Blastomycosis
​Legionellosis 
​Tularemia
​Botulism Infant
Leptospirosis
​Typhoid and Paratyphoid Fever
​Brucellosis
​​Listeria Initiative
​Vaccine Adverse Event Reporting System (VAERS)
​Carbapenem-resistant Organisms (CRO)​
Malaria
Varicella
​Chlamydia​
​Measles
​​Varicella Death Investigation (Form Guidance)
​Cholera and Other Vibrio Illnesses  (Form Guidance)
​Meningitis (Aseptic)
Vibrio (Form Guidance)
​​Cocciodioidomycosis
​Meningitis (Bacterial)
​Viral Hemorrhagic Fever (VH​​F)
​​Cronobacter​
​Meningococcal Disease
​West Nile Virus
​Cyclosporiasis
Meningococcal Disease Supplemental Form​
​Zika Virus​
​Dengue
MERS-CoV (Word)

​Diphtheria
​Mumps 
​
​Encephalitis
​Outbreak (See below)​

​Gastroenteritis ​​(Click Here for Instructions)
​Pertussis​

​Gonorrhea​
​Pneumonia in a Health Care Worker
​
​Haemophilus Influenzae
​Polio
​
​Hansen's Disease (Leprosy)
Psittacosis
​
​Hantavirus
Q-Fever
​
​Hepatitis A Acute
​​Rubella​
​
​Hepatitis B Acute
S​ARS
​
​Perinatal Hepatitis B 
Smallpox
​
​Perinatal Hepatitis B Contact
​​Streptococcus - Group A​​​
​
​Hepatitis C (Initial)
​Streptococcus - Group B
​
​Hepatitis C (Supplemental)
​​Syphilis
​
​​Histoplasmosis
​Tetanus
​



​​
Outbreak Summary Report Forms PDF Microsoft
Word
​COVID-19 Outbreak (all facility types)
 ​PDF ​
​Non-COVID-19 Respiratory Outbreak (all facility types)
​PDF
​
Gastroenteritis Outbreak (all facility types)
 P​DF
Scabies Outbreak PDF Word
Other Daycare Outbreak
 PDF
 Word
​Other School Outbreak
​PDF
​Word
​Other Hospital Outbreak
​PDF
​Word
​Waterborne Illness Outbreak
​PDF
​
     
Foodborne Outbreak Forms    
National Outbreak Reporting System (NORS) Form 52.13
 PDF
National Outbreak Reporting System (NORS) Form 52.13 Guidance PDF  
NORS Guidance Appendices:
 
​​Appendix A: Mode of Transmission for Certain Beverages and Foods or Drinks Containing Ice
 ​PDF ​
​​Appendix B: Reporting Foodborne and Animal Contact Multistate Exposure and Residency Outbreaks
 ​PDF ​
​​Appendix C: Freedom of Information Act (FOIA) Requests and Other Requests for NORS Data
 ​PDF ​
​​Appendix D: ​NORS Guidance for Contributing Factors (CF) in Foodborne Outbreak Reports
 ​PDF ​
​​Appendix E: Available Picklist Values    ​ 
 ​PDF ​