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Get Odh Reportable Disease Form

Nt-care a Child care attendee /staff a Long-term care resident/staff a Not applicable a Yes a Yes a No a Unknown a No a Hispanic a Unknown a Non-Hispanic Ohio Department of Health Ohio Confidential Reportable Disease a Yes a No a Unknown a Unknown Use this form to submit reportable infectious diseases to your local health department (Do not use this form to report HIV / AIDS) Disease reported Patient s last name Address (number and street) City Home telephone ( a Laboratory conf.

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