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Disease Reporting Form

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Healthcare providers, long-term care facilities, schools, and childcare facilities: Use the form below to report state-reportable diseases and conditions directly to Rock County Public Health. 

If you are reporting a Category I disease or condition, please call us at 608-757-5440 in addition to completing this form. If you are calling outside business hours, use the non-emergency 911 line at 608-757-2244.

Return to our For Healthcare Partners webpage for more information on disease reporting.

This form maintains HIPAA compliance through Rock County's IT security systems. If you have concerns about reporting protected health information using this form, please complete a case report form and upload it to WEDSS or fax it to RCPH at 608-758-8423.

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