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Kentucky Reportable Disease Form
Department for Public Health
Division of Epidemiology and Health Planning
275 East Main St., Mail stop HS2EA
Frankfort, KY 406210001
Disease Name ___
EPIC 200 2/2021
Fax
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How to fill out kentucky reportable disease form
How to fill out kentucky reportable disease form
01
Obtain a copy of the Kentucky reportable disease form from the Kentucky Department for Public Health website.
02
Fill out the patient information section with the individual's name, date of birth, address, and contact information.
03
Provide details of the disease being reported, including the date of diagnosis, symptoms, and any relevant medical history.
04
Include the name and contact information of the healthcare provider or facility that diagnosed the disease.
05
Submit the completed form to the Kentucky Department for Public Health according to their specified guidelines.
Who needs kentucky reportable disease form?
01
Healthcare providers, hospitals, and laboratories in Kentucky who diagnose reportable diseases are required to fill out and submit the Kentucky reportable disease form.
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