Wisconsin Division of Public Health Disease Surveillance Manual

Please submit the appropriate follow-up form to the Division of Public Health (DPH)
with the Acute and Communicable Disease Case Report Form (DPH 4151)

DISEASE	CDC	DPH	CDES
AIDS		4264
ARBOVIRAL DISEASES		4151	103
BABESIOSIS			101
BOTULISM, INFANT	52.73
CAT SCRATCH FEVER			102
CHANCROID		4243
CHLAMYDIA		4243
CHOLERA	52.79
EHRLICHIOSIS	55.1
GENITAL HERPES		4243
GONNORRHEA		4243
HEPATITIS A	53.1
HEPATITIS B	53.1
HEPATITIS C	53.1
HEPATITIS D	53.1
HIV INFECTION		4338
Pediatric Cases (< 13 years old) ONLY	50.42B
INFLUENZA- ASSOCIATED PEDIACTRIC DEATHS	PED-FLU
KAWASAKI SYNDROME	55.54
LEGIONELLA	52.56	9069	105
LEPROSY	52.18	9077
LISTERIOSIS	920-04
LYME DISEASE			107
MALARIA	54.1
MEASLES		4077
PLEVIC INFLAMMATORY DISEASE (PID)		4243
PERTUSSIS		4236
PSITTACOSIS		9075
Q FEVER	Q-follow-up form
REYE SYNDROME	55.8
ROCK MOUNTAIN SPOTTED FEVER	55.1
RUBELLA, CONGENITAL SYNDROME	71.17
		4243
SEVERE ACUTE RESPITORY SYNDROME (SARS)	SARS
SYPHILIS		or
		4061
TETANUS	71.15
TOXIC SHOCK SYNDROME	52.3
TRICHINOSIS	54.7
		4000
TUBERCULOSIS		or
		42001
TYPHOID FEVER	52.5
VIBRIOSIS (NON-CHOLERAE)	52.79
WATERBORNE DISEASE OUTBREAKS	52.12

These forms can be found on the HAN. Login, then click on TOPICS, click COMMUNICABLE, then click EPINET and go into REPORT FORMS, another screen will appear and under Associated Links, click Report Forms and the table above will appear and click the appropriate disease form number.