Reporting Communicable Diseases in Travis County 2023

Epidemiology and Public Health Preparedness Division

Epidemiology and Disease Surveillance Unit

5202 E. Ben White Blvd. Ste 600

Austin, TX 78741

Reporting Communicable

Diseases in Travis County

2023

Contents

Letter to Reporting Agencies .......................................................................................................... 1

Letter about Health Insurance Portability and Accountability Act (HIPAA) ................................... 2

Texas Administrative Code Section 97.2 (Communicable Disease Control) .................................. 3

Reporting Phone Numbers and Other Useful Numbers ................................................................. 4

List of Texas Notifiable Conditions .............................................................................................. 5-6

List of Texas Notifiable Conditions by Time Frame ........................................................................ 7

Important Notice about Bacterial Isolates or Specimens ............................................................... 8

Important Notice about Controlled Substance Overdoses………………………………………………………….9

Reporting Forms............................................................................................................................ 10

Infectious Disease Reporting Form ........................................................................................... 10

Varicella (Chickenpox) Reporting Form ..................................................................................... 11

STD Reporting Form ............................................................................................................. 12-13

STD-28 ....................................................................................................................................... 14

Perinatal Hepatitis B Reporting Form ....................................................................................... 15

Letter to Reporting Agencies

March 17, 2023

Dear Reporting Agency,

Thank you for reporting notifiable health conditions to Austin Public Health. Timely reporting allows

Austin Public Health to respond to potential disease outbreaks, mitigate transmission of disease, and

monitor health trends in Travis County.

The purpose of this Reporting Packet is to provide you with the 2022 list of notifiable conditions,

reporting forms, and other helpful information. The packet includes:

1. Letter about Health Insurance Portability and Accountability Act (HIPAA)

2. Texas Administrative Code Section 97.2 (Communicable Disease Control)

3. Reporting Phone Numbers

4. List of Notifiable Conditions in Texas

5. Important Notice about Bacterial Isolates or Specimens

6. Important Notice about Controlled Substance Overdoses

7. Reporting Forms

a. General Infectious Disease

b. Varicella (Chickenpox)

c. STD Reporting Form

d. Perinatal Hepatitis B OB/GYN

e. Perinatal Hepatitis B Labor/Delivery & Postpartum

Reports of disease and reporting forms may be faxed to 512-972-5772.

To report diseases over phone, especially those requiring immediate attention, please call 512-972-5555.

This number is answered during business hours, Monday through Friday, 8 a.m. to 5 p.m, and serves as

our 24/7 emergency on-call line after hours.

Thank you again for your assistance.

Sincerely,

Desmar Walkes, MD Janet Pichette, MS, CEM

Medical Director / Health Authority Chief Epidemiologist

March 17, 2023

To Whom It May Concern:

We understand that there may be some confusion regarding the Health Insurance Portability

and Accountability Act (HIPAA) and release of protected health information to public health

authorities. This letter will clarify the relationship between HIPAA and public health functions.

The Epidemiology and Disease Surveillance Unit is a program within Austin Public Health, the

local health department for the City of Austin and Travis County. Local health departments are

authorized by state law to conduct disease surveillance activities (Texas Health and Safety

Code, Title 2. Health. Chapter 81. Communicable Diseases). Disease surveillance activities or

monitoring the health status to identify and solve community health problems is an essential

function of public health. HIPAA permits use and disclosure of protected health information,

without an individual’s authorization or permission, for 12 national priority purposes. Public

Health Activities is one of the priority purposes.

As a HIPAA covered entity, you may disclose protected health information for public health

activities and purposes to a public health authority that is authorized by law to collect and

receive such information for preventing and controlling disease, injury, or disability. This

includes but is not limited to, the reporting of diseases, injury, vital events such as birth or

death, and the conduct of public health surveillance, public health investigations, and public

health interventions. See 45 Code of Federal Regulations (CFR) 164.512(b)(1).

If you have any questions, please contact me at the Epidemiology and Disease Surveillance Unit

at (512) 972-5555. Thank you for efforts in preventing diseases, promoting health, and

protecting the people of Austin and Travis County.

Kindest Regards,

Janet Pichette, MS, CEM

Chief Epidemiologist

Epidemiology and Disease Surveillance Unit

Austin Public Health

Texas Administrative Code

TITLE 25

HEALTH SERVICES

PART 1

DEPARTMENT OF STATE HEALTH SERVICES

CHAPTER 97

COMMUNICABLE DISEASES

SUBCHAPTER A

CONTROL OF COMMUNICABLE DISEASES

RULE §97.2

Who Shall Report

(a) A physician, dentist, veterinarian, chiropractor, advanced practice nurse, physician assistant, or person

permitted by law to attend a pregnant woman during gestation or at the delivery of an infant shall report, as

required by these sections, each patient (person or animal) he or she shall examine and who has or is

suspected of having any notifiable condition, and shall report any outbreak, exotic disease, or unusual group

expression of illness of any kind whether or not the disease is known to be comm

unicable or reportable. An

employee from the clinic or office staff may be designated to serve as the reporting officer. A physician,

dentist, veterinarian, advanced practice nurse, physician assistant, or chiropractor who can assure that a

designated or appointed person from the clinic or office is regularly reporting every occurrence of these

diseases or health conditions in their clinic or office does not have to submit a duplicate report.

(b) The chief administrative officer of a hospital shall appoint one reporting officer who shall be

responsible for reporting each patient who is medically attended at the facility and who has or is suspected

of having any notifiable condition. Hospital laboratories may report through the reporting officer or

independently in accordance with the hospital's policies and procedures.

blood bank, mobile unit, or other facility in which a laboratory examination of a

ny specimen derived from a

human body yields microscopic, bacteriologic, virologic, parasitologic, serologic, or other evidence of a

notifiable condition, shall report as required by this section.

(d) School authorities, including a superintendent, principal, teacher, school health official, or counselor of

a public or private school and the administrator or health official of a public or private institution of higher

learning should report as required by these sections those students attending school who are suspected of

having a notifiable condition. School administrators who are not medical directors meeting the criteria

described in §97.132 of this title (relating to Who Shall Report Sexually Transmitted Diseases) are exempt

from reporting sexually transmitted diseases.

(e) Any person having knowledge that a person(s) or animal(s) is suspected of having a notifiable condition

should notify the local health authority or the department and provide all information known to them

concerning the illness and physical condition of such person(s) or animal(s).

(f) Sexually transmitted diseases including HIV and AIDS shall be reported in accordance with Subchapter

F of this chapter (relating to Sexually Transmitted Diseases Including Acquired Immunodeficiency

Syndrome (AIDS) and Human Immunodeficiency Virus (HIV)).

(g) Failure to report a notifiable condition is a Class B misdemeanor under the Texas Health and Safety

Code, §81.049.

(h) The Health Insurance Portability and Accountability Act (HIPAA) allows reporting without

authorization for public health purposes and where required by law. Title 45 Code of Federal Regulations

§164.512(a) and (b).

Source Note: The provisions of this §97.2 adopted to be effective March 16, 1994, 19 TexReg 1453;

amended to be effective March 5, 1998, 23 TexReg 1954; amended to be effective January 1, 1999, 23

TexReg 12663; amended to be effective March 26, 2000, 25 TexReg 2343; amended to be effective

December 20, 2000, 25 TexReg 12426; amended to be effective August 5, 2001, 26 TexReg 5658;

amended to be effective June 5, 2007, 32 TexReg 2997; amended to be effective December 20, 2012, 37

TexReg 9777; amended to be effective April 3, 2016, 41 TexReg 2317

REPORTING PHONE NUMBERS

Reportable diseases/conditions occurring in Travis County shall be reported to Austin Public Health. Refer to the Texas

Department of State Health Services (TDSHS) listing for names of reportable diseases/conditions and other information.

Disease/Condition

Phone

Fax

General Communicable Diseases

(512) 972-5555

(512) 972-5772

HIV/AIDS

(512) 972-5144 or

(512) 972-5142 or

(512) 972-5583

(512) 972-5772

Perinatal Hepatitis B Program

(512) 972-6218

(512) 972-6287

STD Reporting Syphilis

Chlamydia & Gonorrhea

(512) 972-5310

(512) 972-5313 or

(512) 972-5314 or

(512) 972-5829 or

(512) 972-5809

(512) 972-5772

Tuberculosis Reporting

(512) 972-5448

(512) 972-5451

OTHER USEFUL PHONE NUMBERS

Department

Phone

Animal Control

311

Environmental Health

311

Immunizations

(512) 972-5520

Refugee Screening Clinic

(512) 972-6210

STI Clinic

(512) 972-5430

TB Clinic

(512) 972-5460

Vaccines for Children Program

(512) 972-5414

E59-11364 (Rev. 1/08/23) Expires 12/31/23 -- Go to http://www.dshs.texas.gov/idcu/investigation/conditions/ or call your local or regional health department for

updates.

A – L

When to Report

L – Y

When to Report

*Acquired immune deficiency syndrome (AIDS)

Within 1 week

Legionellosis

Within 1 week

Amebic meningitis and encephalitis

Within 1 week

Leishmaniasis

Within 1 week

Anaplasmosis

Within 1 week

Listeriosis

2, 3

Within 1 week

Anthrax

2, 3, 25

Call Immediately

Lyme disease

Within 1 week

Arboviral infections

2, 4, 5

Within 1 week

Malaria

Within 1 week

*Asbestosis

Within 1 week

Measles (rubeola)

Call Immediately

Ascariasis

Within 1 week

Meningococcal infection, invasive (Neisseria meningitidis)

2, 3

Call Immediately

Babesiosis

2,5

Within 1 week

Mumps

Within 1 work day

Botulism (adult and infant)

2, 3, 7, 25

Call Immediately

Paragonimiasis

Within 1 week

Brucellosis

3, 25

Within 1 work day

Pertussis

Within 1 work day

Campylobacteriosis

Within 1 week

*Pesticide poisoning, acute occupational

Within 1 week

*Cancer

See rules

Plague (Yersinia pestis)

2, 3, 25

Call Immediately

Candida auris

2, 3, 10

Within 1 work day

Poliomyelitis, acute paralytic

Call Immediately

Carbapenem-resistant Enterobacteriaceae (CRE)

2, 11

Within 1 work day

Poliovirus infection, non-paralytic

Within 1 work day

Chagas disease

2, 5

Within 1 week

Prion disease such as Creutzfeldt-Jakob disease (CJD)

2, 12

Within 1 week

Chancroid

Within 1 week

Q fever

Within 1 work day

*Chickenpox (varicella)

Within 1 week

Rabies, human

Call Immediately

Chlamydia trachomatis infection

Within 1 week

Rubella (including congenital)

Within 1 work day

Contaminated sharps injury

Within 1 month Salmonellosis, including typhoid fever

2, 3

Within 1 week

*Controlled substance overdose

Report Immediately

Shiga toxin-producing Escherichia coli

2, 3

Within 1 week

Coronavirus, novel

2, 16

Call Immediately

Shigellosis

Within 1 week

Coronavirus Disease 2019 (COVID-19)

Within 1 week

*Silicosis

Within 1 week

Cryptosporidiosis

Within 1 week

Smallpox

2, 25

Call Immediately

Cyclosporiasis

Within 1 week

*Spinal cord injury

Within 10 work days

Cysticercosis

Within 1 week

Spotted fever rickettsiosis

Within 1 week

Diphtheria

2, 3

Call Immediately

Streptococcal disease (S. pneumo.

2, 3

), invasive

Within 1 week

*Drowning/near drowning

Within 10 work days

*Syphilis – primary and secondary stages

1, 19

Within 1 work day

Echinococcosis

Within 1 week

*Syphilis – all other stages including congenital syphilis

1,19

Within 1 week

Ehrlichiosis

Within 1 week Taenia solium and undifferentiated Taenia infection

Within 1 week

Fascioliasis

Within 1 week

Tetanus

Within 1 week

*Gonorrhea

Within 1 week

Tick-borne relapsing fever (TBRF)

Within 1 week

Haemophilus influenzae, invasive

2, 3

Within 1 week

*Traumatic brain injury

Within 10 work days

Hansen’s disease (leprosy)

Within 1 week

Trichinosis

Within 1 week

Hantavirus infection

Within 1 week

Trichuriasis

Within 1 week

Hemolytic uremic syndrome (HUS)

Within 1 week

Tuberculosis (Mycobacterium tuberculosis complex)

3, 21

Within 1 work day

Hepatitis A

Within 1 work day

Tuberculosis infection

Within 1 week

Hepatitis B, C, and E (acute)

Within 1 week

Tularemia

2, 3, 25

Call Immediately

Hepatitis B infection identified prenatally or at delivery (mother)

Within 1 week

Typhus

Within 1 week

Hepatitis B, perinatal (HBsAg+ < 24 months old) (child)

Within 1 work day

Vancomycin-intermediate Staph aureus (VISA)

2, 3

Call Immediately

Hookworm (ancylostomiasis)

Within 1 week

Vancomycin-resistant Staph aureus (VRSA)

2, 3

Call Immediately

*Human immunodeficiency virus (HIV), acute infection

1, 23

Within 1 work day

Vibrio infection, including cholera

Within 1 work day

*Human immunodeficiency virus (HIV), non-acute infection

1, 23

Within 1 week

Viral hemorrhagic fever (including Ebola)

2, 25

Call Immediately

Influenza-associated pediatric mortality

Within 1 work day

Yellow fever

Call Immediately

Influenza, novel

Call Immediately

Yersiniosis

Within 1 week

*Lead, child blood, any level & adult blood, any level

Call/Fax Immediately

In addition to specified reportable conditions, any outbreak, exotic disease, or unusual group expression of disease that may be of

public health concern should be reported by the most expeditious means available. This includes any case of a select agent

See select agent list at https://www.selectagents.gov/selectagentsandtoxinslist.html

*See condition-specific footnotes for reporting contact information

Texas Notifiable

Conditions - 2023

Report all Confirmed and Suspected cases

Unless noted by*, report to your local or regional health department using number above or

find contact information at http://www.dshs.texas.gov/idcu/investigation/conditions/contacts/

24/7 Number for Immediately Reportable – 1-800-705-

E59-11364 (Rev. 1/08/23) Expires 12/31/23 -- Go to http://www.dshs.texas.gov/idcu/investigation/conditions/ or call your local or regional health department for

updates.

Texas Notifiable Conditions Footnotes - 2023

Please refer to specific rules and regulations for HIV/STD reporting and who to report to at:

http://www.dshs.texas.gov/hivstd/healthcare/reporting.shtm.

Reporting forms are available at http://www.dshs.texas.gov/idcu/investigation/forms/ and investigation forms at

http://www.dshs.texas.gov/idcu/investigation/. Call as indicated for immediately reportable conditions.

Lab samples of the following must be sent to the Department of State Health Services, Laboratory Services Section, 1100 West 49th Street, Austin, Texas

78756-3199 or other public health laboratory as designated by the Department of State Health Services: Bacillus anthracis isolates (also requested-

Bacillus cereus isolates that may contain anthrax toxin genes from patients with severe disease or death), Clostridium botulinum isolates, Brucella

species isolates, Candida auris isolates, Corynebacterium diphtheriae isolates, Haemophilus influenzae isolates from normally sterile sites in children

under five years old, Listeria monocytogenes isolates, Neisseria meningitidis isolates from normally sterile sites or purpuric lesions, Yersinia pestis

isolates, Salmonella species isolates (also requested - specimens positive for Salmonella by culture-independent diagnostic testing (CIDT) methods),

Shiga toxin-producing Escherichia coli (all E.coli O157:H7 isolates and any E.coli isolates or specimens in which Shiga toxin activity has been

demonstrated), isolates of all members of the Mycobacterium tuberculosis complex, Staphylococcus aureus with a vancomycin MIC greater than 2

µg/mL (VISA and VRSA), Streptococcus pneumoniae isolates from normally sterile sites in children under five years old, Francisella tularensis isolates,

and Vibrio species isolates (also requested - specimens positive for Vibrio by culture-independent diagnostic testing (CIDT) methods). Pure cultures (or

specimens) should be submitted as they become available accompanied by a current department Specimen Submission Form. See the

Texas

Administrative Code (TAC) Chapter 97: §97.3(a)(4), §97.4(a)(6), and §97.5(a)(2)(C). Call 512-776-7598 for specimen submission information.

Arboviral infections including, but not limited to, those caused by California serogroup viruses, chikungunya virus, dengue virus, Eastern equine

encephalitis (EEE) virus, St. Louis encephalitis (SLE) virus, Western equine encephalitis (WEE) virus, West Nile (WN) virus, and Zika virus.

All blood collection centers should report all donors with reactive tests for West Nile virus, Zika virus, Babesia species, and Trypanosoma cruzi (Chagas

disease) to the DSHS Zoonosis Control Branch. If your center uses a screening assay under an IND protocol, please include results of follow-up testing as

well. To report, send a secure email to W[email protected]exas.gov

or fax the report to 512-776-7454. Providing the following: Collection Agency; Unique BUI

#; Test Name, Collection Date; Last Name, First Name, Donor Phone Number, Donor Address, Date of Birth, Age, Sex, Race, and Hispanic Ethnicity (Y/N).

If your location has a city or county health department, DSHS recommends that you also share this same information with them.

For asbestos reporting information see http://www.dshs.texas.gov/epitox/Asbestosis-and-Silicosis-Surveillance/.

Report suspected botulism immediately by phone to 888-963-7111.

For pesticide reporting information see https://www.dshs.texas.gov/sites/default/files/epitox/pestrptfrm.pdf

For more information on cancer reporting rules and requirements go to http://www.dshs.texas.gov/tcr/reporting.shtm.

See additional Candida auris reporting information at https://www.dshs.texas.gov/IDCU/health/antibiotic_resistance/Cauris-Home.aspx.

See additional CRE reporting information at http://www.dshs.texas.gov/IDCU/health/antibiotic_resistance/Reporting-CRE.doc.

For purposes of surveillance and notification, Prion disease such as Creutzfeldt-Jakob disease (CJD) also includes Kuru, Gerstmann-Sträussler-Scheinker (GSS)

disease, fatal familial insomnia (FFI), sporadic fatal insomnia (sFI), Variably Protease-Sensitive Prionopathy (VPSPr), familial CJD (fCJD) or genetic CJD (gCJD),

variant CJD (vCJD), iatrogenic CJD (iCJD) and any novel prion disease affecting humans.

Call your local health department for a copy of the Varicella Reporting Form with their fax number. The Varicella (Chickenpox) Reporting Form should be

used instead of an Epi-1 or Epi-2 morbidity report.

Applicable for governmental entities. Not applicable to private facilities. (TAC §96.201) Initial reporting forms for Contaminated Sharps at

http://www.dshs.texas.gov/idcu/health/infection_control/bloodborne_pathogens/reporting/.

To report a Controlled Substance Overdose, go to https://odreport.dshs.texas.gov/.

Novel coronavirus causing severe acute respiratory disease includes Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome

(SARS). Call immediately for SARS, MERS, or any other novel coronavirus cases.

For silicosis reporting information see http://www.dshs.texas.gov/epitox/Asbestosis-and-Silicosis-Surveillance/.

Please refer to specific rules and regulations for injury reporting and who to report to at http://www.dshs.texas.gov/injury/rules.shtm.

Laboratories should report syphilis test results within 3 work days of the testing outcome.

Reporting forms are available at https://www.dshs.texas.gov/idcu/disease/hansens/forms.shtm.

Reportable tuberculosis disease includes the following: suspected tuberculosis disease pending final laboratory results; positive nucleic acid

amplification tests; clinically or laboratory-confirmed tuberculosis disease; and all Mycobacterium tuberculosis (M. tb) complex including

M. tuberculosis, M. bovis, M. africanum, M. canettii, M. microti, M. caprae, and M. pinnipedii. See rules and reporting information at

http://www.dshs.texas.gov/idcu/disease/tb/reporting/

TB infection is determined by a positive result from an FDA-approved Interferon-Gamma Release Assay (IGRA) test such as T-Spot TB or

QuantiFERON - TB GOLD In-Tube Test or a tuberculin skin test, and a normal chest radiograph with no presenting symptoms of TB disease.

See rules and reporting information at http://www.dshs.texas.gov/idcu/disease/tb/reporting/

. Please report skin test results in millimeters.

Any person suspected of having HIV should be reported, including HIV exposed infants.

For lead reporting information see http://www.dshs.texas.gov/lead/Reporting-Laws-Administrative-Code.aspx.

Please secure select agent isolates and specimens in accordance with the guidance in the Select Agent Regulation, and immediately initiate a

consultation with public health regarding need for further testing or sequencing. Notify any transfer facilities of any test results of high

consequence/interest.

Texas Notifiable Conditions 2023 (by reporting timeframe)

Both suspected and confirmed cases are IMMEDIATELY Reportable!

CALL 512-972-5555 (365/24/7)

• Anthrax

• Botulism (adult & infant)

• Controlled substance overdose (see rules)

• Coronavirus, novel

• Diphtheria

• Influenza, Novel

• Lead, childhood/adult, any level (see rules)

• Measles (rubeola)

• Meningococcal infection, invasive (Neisseria

meningitidis)

• Plague (Yersinia pestis)

• Poliomyelitis, acute paralytic

• Rabies, human

• Smallpox

• Staph. Aureus, vancomycin-resistant (VISA &

VRSA)

• Tularemia

• Viral hemorrhagic fever (including Ebola)

• Yellow fever

Report within ONE WORKING DAY

• Brucellosis

• Candida auris

• Carbapenem resistant Enterobacteriaceae (CRE)

• Hepatitis A (acute)

• Hepatitis B, perinatal (HBsAg+ <24 months) (child)

• Human immunodeficiency virus (HIV), acute infection

• Influenza-associated pediatric mortality

• Mumps

•

• Pertussis

• Poliovirus infection, non-paralytic

• Q fever

• Rubella (including congenital)

• Syphilis, primary & secondary stages

• Tuberculosis disease (M. tuberculosis complex)

• Vibrio infection, including cholera

Report within ONE WEEK

• Acquired immune deficiency

syndrome (AIDS)

• Amebic Meningitis & Encephalitis

• Anaplasmosis

• Arboviral Infection

• Asbestosis

• Ascariasis

• Babesiosis

• Campylobacteriosis

• Cancer

• Chagas Disease

• Chancroid

• Chickenpox (Varicella)

• Chlamydia trachomatis infection

• Coronovirus Disease 2019 (COVID-

19)

• Cryptosporidiosis

• Cyclosporiasis

• Cysticercosis

• Echinococcosis

• Ehrlichiosis

• Fascioliasis

• Gonorrhea

• Haemophilus influenza, invasive

• Hansen’s disease (Leprosy)

• Hantavirus infection

• Hemolytic Uremic Syndrome

(HUS)

• Hepatitis B, C, and E (acute)

• Hepatitis B identified prenatally

or at delivery (mother)

• Hookworm (ancylostomiasis)

• Human immunodeficiency virus

(HIV) non-acute infection

• Legionellosis

• Leishmaniasis

• Listeriosis

• Lyme disease

• Malaria

• Paragonimiasis

• Pesticide poisoning, acute

occupational

• Prion disease such as Creutzfeldt-

Jakob disease (CJD)

• Salmonellosis, including typhoid

fever

• Shiga toxin-producing

Escherichia coli

• Shigellosis

• Silicosis

• Spotted fever group rickettsioses

• Streptococcal disease (S.

pneumo), invasive

• Syphilis, all other stages

including congenital syphilis

• Taenia solium & undifferentiated

Taenia infection

• Tetanus

• Tick-borne relapsing fever

(TBRF)

• Trichinosis

• Trichuriasis

• Tuberculosis infection

• Typhus

• Yersiniosis

Report within 10 WORKING DAYS (See Rules)

• Drowning/Near Drowning

• Spinal Cord Injury

• Traumatic brain injury

Report within ONE MONTH

• Contaminated sharps injury

Report by the most expeditious means available

• In addition to specified reportable conditions, any outbreak, exotic disease, or unusual group expression of disease that

may be of public health concern should be reported by the most expeditious means available

Important Notice about Bacterial Isolates or Specimens

Pure cultures (or specimens) of the following must be submitted as they become available

accompanied by a current department Specimen Submission Form to:

Department of State Health Services

Laboratory Services Section

1100 West 49th Street, Austin, Texas 78756-3199

• Arboviral infections including, but not limited, those caused by California serogroup viruses,

chikungunya virus, dengue virus, Eastern equine encephalitis (EEE), St. Louis encephalitis (SLE) virus,

Western equine encephalitis (WEE) virus, West Nile (WN) virus, and Zika virus

• Bacillus anthracis isolates (also requested—Bacillus cereus isolates that may contain anthrax toxin

genes from patients with severe disease or death)

• Brucella species isolates

• Candida auris isolates

• Clostridium botulinum isolates

• Corynebacterium diphtheria isolates

• Francisella tularensis isolates

• Haemophilus influenzae isolates from normally sterile sites in children under five years old

• Listeria monocytogenes isolates

• Mycobacterium tuberculosis complex isolates

• Neisseria meningitidis isolates from normally sterile sites or purpuric lesions

• Salmonella species isolates (also requested – specimens positive for Salmonella by culture-

independent diagnostic testing (CIDT) methods)

• Shiga toxin-producing Escherichia coli (all E.coli O157:H7 isolates and any E.coli isolates or specimens in

which Shiga toxin activity has been demonstrated)

• Staphylococcus aureus with a vancomycin MIC greater than 2 μg/mL (VISA and VRSA)

• Streptococcus pneumoniae isolates from normally sterile sites in children under five years old

• Vibrio species isolates (also requested - specimens positive for Vibrio by culture-independent

diagnostic testing (CIDT) methods)

• Yersinia pestis isolates

All blood collection centers should report all donors with reactive tests for West Nile virus, Zika virus,

Babesia species, and Trypanosoma cruzi (Chagas disease)

See the Texas Administrative Code (TAC) Chapter 97: §97.3(a)(4), §97.4(a)(6), and §97.5(a)(2)(C). Call 512-

776-7598 for specimen submission information.

Lab Test/Specimen Submission Instructions

Laboratory Services Section Forms, Including G-2A and G-2B

Last updated March 17, 2023

Important Notice about Controlled Substance Overdoses

By Texas state law, Penalty Group 1 controlled substance overdoses shall be reported to the

Department of State Health Services immediately.

Texas Health and Safety Code §161.042 requires health care providers, or the administrator,

superintendent, or other person in charge of a hospital, sanatorium, or other institution in which

an overdose of a controlled substance listed in Penalty Group 1 is attended, treated, or in which

attention or treatment is requested, report all overdoses from substances listed in Penalty Group 1.

An overdose is defined as an accidental or intentional Penalty Group 1 drug effect, direct or

indirect, resulting in an unfavorable health event.

Penalty Group 1 drugs are classified by Texas Health and Safety Code §481.102 as opiates, opioids,

cocaine, opiate and opium derivatives, and other drugs. The complete list of reportable Penalty

Group 1 drugs as defined by the

Texas Health and Safety Code §481.102.

Failing to report is a misdemeanor punishable by confinement in jail for not more than six months,

or by a fine of not more than $100.

To report a controlled substance overdose, please use the reporting link below.

Please do not include any identifiable patient information, such as, patient name, address, or any

other information concerning the patient's identity.

Controlled Substance Overdose Reporting Form

Last updated March 14, 2022

Revised 1/2020

Infectious Disease Report

This form may be used to report suspected cases and cases of notifiable conditions in Texas, as listed on the current Texas

Notifiable Conditions List (http://www.dshs.state.tx.us/idcu/investigation/conditions

). In addition, any outbreak, exotic

disease, or unusual group expression of disease that may be of public health concern should be reported by the most

expeditious means available. You may be contacted to further investigate this Infectious Disease Report.

Report cases to Austin Public Health by faxing this form to (512) 972-5772 or calling (512) 972-5555

PATIENT INFORMATION

Last Name

First Name

Phone (Primary)

Phone (Secondary)

Date of Birth

Age

Sex

☐

Male

☐ Female

Ethnicity

☐

Hispanic

☐ Not Hispanic

Race

☐

White

☐ Asian

☐

Black

☐ Other

☐

Unknown

Address

City

State

Zip Code

County

CLINICAL INFORMATION

Disease or Condition

Illness Onset Date

Test Name/Type

Date of Collection

Specimen Source

☐

Blood

☐ Nose

☐

Throat

☐ Stool

☐

Urine

☐ Other ______

Result (attach copy)

Treatment Name

Treatment Start Date

Treatment Duration

REPORTING INFORMATION

Reporter Name

Date Reported

Reporter Phone

Healthcare Provider Name

Provider Address

Provider Phone

PATIENT INFORMATION

Last Name

First Name

Phone (Primary)

Phone (Secondary)

Date of Birth

Age

Sex

☐

Male

☐ Female

Ethnicity

☐

Hispanic

☐ Not Hispanic

Race

☐

White

☐ Asian

☐

Black

☐ Other

☐

Unknown

Address

City

State

Zip Code

County

CLINICAL INFORMATION

Disease or Condition

Illness Onset Date

Test Name/Type

Date of Collection

Specimen Source

☐

Blood

☐ Nose

☐

Throat

☐ Stool

☐

Urine

☐ Other ______

Result (attach copy)

Treatment Name

Treatment Start Date

Treatment Duration

REPORTING INFORMATION

Reporter Name

Date Reported

Reporter Phone

Healthcare Provider Name

Provider Address

Provider Phone

NBS ID:_______________ Case Investigation ID: CAS_________________TX01

VARICELLA (chickenpox) Reporting Form

Please use this form to report cases of Varicella to your local health office. Please complete as many fields as possible and fax completed

forms to APH at (512) 972-5772 at the end of every week. A report can still be submitted if all questions cannot be answered.

PATIENT INFORMATION:

Last Name: ________________ First: _____________________

DOB: ___/___/____ Age: ____ Sex: ____

Address: ___________________ City: _______________

Zip Code: __________ Phone: ________________

DEMOGRAPHICS:

Race:  White  Black or African-American  Asian

 Pacific Islander  Native American/Alaskan  Unknown

Hispanic:  Yes  No  Unknown

Place of Birth:  U.S.A.  Other___________________

Is the patient pregnant?  Yes  No  Unknown

REPORTING INFORMATION:

Name of Person Reporting: __________________________

Agency/Organization Name: _________________________

Phone: __________________________________________

Address: _________________________________________

City: ___________ Zip: _________ County: _____________

Date Reported: ___/___/_____

Health Department: ________________________________

Was the patient hospitalized for this disease?

 Yes*  No *If yes, please send medical records

Did patient visit a healthcare provider during this illness?

 Yes Date: ___/___/_____  No

Physician: __________________________

Did the patient develop any complications?  Yes  No

Specify: ___________________________________

Is the patient immunocompromised?  Yes  No

Treated with any antiviral for this illness?  Yes  No

If yes, specify: ______________________ Start date: ____/____/_____

Hospital: _________________________________________

Admit date: ____/___/____ Discharge date: ___/___/____

Is this patient a contact to another known varicella or

shingles case?  Yes  No  Unknown

Name of contact: __________________ Phone: _____________

Outbreak?  Yes**  No (*complete the Varicella Outbreak

Report Form, one per outbreak)

**NEDSS Outbreak Name: ____________________________

CLINICAL DATA:

Illness Onset Date ____/____/_____ Illness duration: ____ days

Rash Onset Date ____/____/_____

Rash Location:  Generalized  Focal  Unknown

If generalized, first noted: (check all that apply)

 Face/head  Legs  Trunk  Arms  Inside Mouth

 Other (specify) _______________________

If focal, specify dermatome: _______________

Number of lesions:

 <50 (specify)___________  50-249  250- 499  500+

If <50, how many of each:

 Macules #_____  Papules #____  Vesicles #____

Did the rash crust?  Yes, rash lasted _____ days before crusting

 No, rash lasted ____days  Unknown

Fever?Yes, temperature ______F

Date of Fever onset: ____/____/______ No. of days ______

 No

 Unknown

Character of Lesions:

Mostly Macular/Papular?

Mostly Vesicular?

Hemorrhagic?

Itchy?

Scabs?

Crops/Waves?



 Yes /  No /  Unknown

LABORATORY DATA: Testing done?  Yes  No  Unknown

Ordering Facility: ___________________

 DFA Result: ________ Date of test: ___/___/____

 PCR Result: ________ Date of test: ___/___/____

 Culture Result: ________ Date of test: ___/___/____

 IgM Result: ________ Date of test: ___/___/____

 IgG Acute Result: ________ Date of test: ___/___/____

Conv Result: ________ Date of test: ___/___/____

Previous History of Disease?  Yes  No

Date of Disease ____/____/_____ Age at diagnosis: _____ years

Diagnosed by whom:

 Parent/friend  Physician/Health Care Provider  Other

Varicella Vaccination?  Yes  No

Number of Doses Received?  1  2  3

Date(s) of Varicella Vaccine:

Dose: ____/____/____ Type:  MMRV  Varicella

Did the patient attend:  School  Day Care  Work  College  Other___________________

Name of institution: __________________________ City: ________________

Transmission Setting (Setting of Exposure):  Athletics  College  Community  Correctional Facility  Day Care  Doctor’s office  Home 

Hospital ER  Hospital Outpatient Clinic  Hospital Ward  International Travel  Military  Place of Worship  School  Work  Unknown 

Other ________________________

TEXAS DEPARTMENT OF STATE HEALTH SERVICES STOCK NO. EF11-11046

EMERGING AND ACUTE INFECTIOUS DISEASE BRANCH REVISED 03/2021

CONFIDENTIAL STD CASE REPORT FORM

AUSTIN PUBLIC HEALTH DEPARTMENT, 5202 E. Ben White, Ste 600, Austin, TX 78741

PHONE: (512) 972-5555 | FAX: (512) 972-5772

APH-EDSU-S-27

Revised March 2021

PATIENT INFORMATION

Last Name

First Name

Date of Birth:

Age

Address:

Phone Number:

Work Number:

City:

State:

Zip code:

Emergency Contact Number:

Sex: ☐ Male ☐ Female Marital Status:

☐

S ☐ M ☐ W ☐ Is patient pregnant? ☐ Yes ☐ No Weeks: _______

Race (check all that apply): ☐ American Indian or Alaskan Native ☐ Black or African American ☐ Asian

☐ White ☐ Native Hawaiian or Pacific Islander ☐ Unknown

Ethnic Origin: ☐ Hispanic or Latino ☐ Not Hispanic or Latino

CLINICAL INFORMATION

Exam Reason:

☐ Partner Referral ☐ Referred by Partner ☐ Screening Jail/Prison ☐ STD Exposure ☐ Prenatal

☐ Delivery ☐ Volunteer ☐ Referred by Another Provider

☐

Other: ______________________________

Site / Specimen (check all that apply):

☐ Cervix ☐ Pharynx ☐ Rectum ☐ Urethra ☐ Urine

☐

Vagina

☐

Blood

Clinical Information (check all that apply):

☐

Asymptomatic

☐

Symptomatic

☐

Rash

☐

Chancre (sore/lesion ☐ Condyloma ☐ Alopecia

STD Lab Result(s): (Please fax lab results with report)

Performing laboratory: ______________________________ Date of Collection: ____________

☐ Chancroid

☐

positive

☐

negative

☐ Chlamydia ☐ positive ☐ negative

☐ Gonorrhea ☐ positive ☐ negative

☐

Pelvic Inflammatory Disease (Syndrome)

Treated:

☐

Yes

☐

No Date: _________________

☐ Azithromycin ☐ 1 g ☐ 2 g

☐ Ceftriaxone 500 mg in a single dose

☐ Other: _______________________

Syphilis Lab Result(s): (Please fax lab results with report)

Performing laboratory: ______________________________ Date of Collection: ____________

☐

700 – Syphilis

☐ 710 – Primary Syphilis (lesions)

☐ 720 – Secondary Syphilis (symptoms)

☐ 730 – Early latent Syphilis (<1 Year)

☐ 745 – Late Latent Syphilis (<1 year)

☐ 750 – Latent Syphilis w/ clinical manifestations

☐ 790 – Congenital Syphilis

Neurological Involvement: ☐ Yes ☐ No ☐ Unknown

Confirmatory Lab (i.e TPPA): ☐ positive

☐

negative

Titer (RPR/VDRL): ☐ Not reactive ☐ 1: _____________

History (Last RPR) DOC: __________ Titer: ________

Treated:

☐

Yes

☐

Date(s): ___________ ___________ ___________

☐ Bicillin 250 MU IM ☐ X1 ☐ X3

☐ Doxycycline 100 mg BID ☐ X7 ☐ X14 ☐ X28

☐ Ceftriaxone (Rocephin) ☐ 250 mg ☐ 500mg __

☐ Other ___________________________

Please call (512)-972-5144 or 5145

Report HIV/AIDS, including test performed during

prenatal visits.

Notes:

FACILITY INFORMATION

Physician or Facility Name

Facility Address

Contact Person:

Phone Number:

CONFIDENTIAL STD CASE REPORT FORM

AUSTIN PUBLIC HEALTH DEPARTMENT, 5202 E. Ben White, Ste 600, Austin, TX 78741

PHONE: (512) 972-5555 | FAX: (512) 972-5772

APH-EDSU-S-27

Revised March 2021

Please use form S-27 to report all notifiable Sexually Transmitted Diseases. Please complete all sections of this

form using available data. If a response is unknown, please leave that value blank. Reporting rules mandate that

positive lab results and disease diagnoses must be reported within the indicated time frames, regardless of

treatment status. A second report should be sent as needed to document successful treatment.

Codes for form STD-27

100 – Chancroid

200 – Chlamydia

300 – Gonorrhea

490 – Pelvic Inflammatory Disease (Syndrome)

600 – Lymphogranuloma Venereum (LGV)

700 – Syphilis

710 – Primary Syphilis (lesions)

720 – Secondary Syphilis (symptoms)

730 – Early latent Syphilis (<1 Year)

745 – Late Latent Syphilis (<1 year)

750 – Latent Syphilis with Symptomatic Manifestations

790 – Congenital Syphilis

900 – HIV (non-AIDS)

950 – AIDS (Syndrome)

Special Instructions

• Please use the provided “Notes/Symptoms” section to document all symptoms of 710/720, both observed

and as reported by patient, as this will assist in properly staging this infection.

• Please document the last known RPR titer, or any previous negative testing for 700.

• Please note all other STD laboratory results (including non-reactive results) when positive lab is collected in

conjunction with additional STD testing.

• Please document all lab results (including non-reactive results) when positive lab was ordered as part of a

comprehensive testing algorithm (e.g.: 700 RPR + 700 Confirmatory).

• While reporting on this document serves as proof of timely report, additional information is required on

900 patients. Please call 512-972-5145 or 512-972-5144, and staff will assist you with reporting all of the

required information.

• It is normal for various representatives of the Health Department to contact you during all stages of the

Public Health Follow-up process to obtain additional patient information.

Please call 512-972-5555 with any additional questions regarding HIV/STD reporting.

Please fax all completed forms to 512-972-5772. Alternately, this form may be mailed to:

Austin Public Health

5202 E. Ben White, Ste 600

Austin, Texas 78741

Attn: Surveillance Program

Austin Public Health

5202 E Ben White Bldg 600, Austin, TX 78741

Phone: (512) 972-5555 Fax: (512) 972-5772

General Reporting Form

(Name of Laboratory) (Address) (City) (State) (Zip) (Phone Number)

REPORT PERIOD: FROM TO .

Subm

it form weekly to local or regional health departments.

Test

Name

Results

(Titer if

applicable)

Date of

Specimen

Collection

Date of Lab

Analysis

Patient’s Name (Last, First, MI): Patient’s Address

(Including, City, County & Zip)

DOB Sex Race Hisp

Y/N

Physician/Facility’s

Name, Address, City, Zip & Phone No.

Preg/

Mat *

NOTIFICATION OF LABORATORY TEST FINDINGS INDICATING PRESENCE OF

CHLAMYDIA TRACHOMATIS, GONORRHEA, SYPHILIS, CHANCROID, HIV INFECTIONS

OR SUPRESSED CD4 COUNTS

Laboratory Supervisor Date

STD-28

Updated 04/1/2021

PERINATAL HBV HOSPITAL & PROVIDER

PORTAL

PAPER FORMS WILL NOT BE ACCEPTED AS OF

AUGUST 1, 2022.

Labs, hospitals, and providers should be provided with the

following link:

https://txhhs.force.com/DSHSPeriHepBPreventionPortal/s/

The public portal is intended to take the place of emails and faxes from labs, hospitals,

and providers. All submissions will be live upon entry into the database.

Submitters will also be able to upload supporting documents with their submissions. All

submitters will be required to include an email address as they will receive an automated

confirmation email notifying them that their submission was successful.

• Submitters will click on the tab that is needed.

• Submitters will complete all fields with an asterisk and may upload

supplemental documents as needed.

• Submitters then click Submit.