Form Number

Category / Form Name

User Guide

Health Care Professionals

MHSU-6781

Provider Report Form for Sexually Transmitted and Blood-Borne Infections (STBBI) and STI Treatment

Instructions

MHSU-4487

STBBI Case Report Form for Point of Care/Rapid Testing

MHSU-0013

Clinical Notification of Reportable Diseases or Conditions

Referral to Public Health: HIV Care Engagement Request Form

Respiratory Diseases

Coronavirus Disease 2019 (COVID-19) forms have been removed as individual case and contact management is no longer occurring.

MHSU-7274

Severe Acute Respiratory Infection (SARI) and Emerging Respiratory Pathogens – Case Report Form

Emerging Respiratory Pathogens (Public Health Agency of Canada)

Weekly Reporting for Hospitalizations, ICU Admissions, and Deaths with Laboratory-Confirmed Influenza: 2022/2023 Season

Reporting Requirements

Communicable Diseases

Information can be found here for the collection of Racial/Ethnic Identity, including the collection of First Nations, Metis and Inuit information. A script and training video is also available.

Documenting Geography for Communicable Disease Investigations in PHIMS

MHSU-0002

Communicable Disease Control Investigation Form

Instructions

MHSU-0003

Mpox Investigation Form

Instructions

MHSU-0003a

Mpox Contact Investigation Form

User Guide for Completion of Surveillance Forms for Reportable Diseases

Overall User Guide

MHSU-6784

STI Case Investigation Form For Chlamydia, Gonorrhea, Chancroid and LGV Infections

Instructions

MHSU-6782

STBBI Contact Investigation Form – Contact Form

Instructions

MHSU-6780

Hepatitis B and C, HIV, and Syphilis Investigation Form – Case Form

Instructions

MHSU-2667

Congenital Syphilis Investigation Form

Instructions

MHSU-4482

HIV Case Report Form for Anonymous Testing

MHSU-2437

HIV/AIDS Case Report – use for reporting AIDS cases only

Vaccine Preventable Diseases

MHSU-8733

Vaccine Preventable Disease Investigation Form

Instructions

Immunization

MHSU-2334

Reporting of Adverse Events Following Immunization (AEFI)

User Guide to Completion and Submission of the AEFI Reports

IIFHCP

Immunization Input Form for Health Care Providers

Take Home Naloxone Program and Substance Surveillance

Enteric, Food and Water-borne Diseases

MHSU-3265

Shiga toxin-producing E.coli (STEC) Food Recall Questionnaire

MHSU-7256

Salmonella Food Recall Questionnaire

MHSU-4372

Hepatitis A Food Recall Questionnaire

MHSU-5478

Invasive Listeriosis Questionnaire

Vector-borne and Other Zoonotic Diseases

MHSU-8232

Tick-Borne Disease Clinical Case Report Form

Instructions

MHSU-9684

West Nile virus Human Case Investigation Form

Instructions

MHSU-7224

Report of Suspected Rabies Exposure

Outbreaks

Enteric Outbreak Summary Report AND Respiratory/Vaccine Preventable Disease Outbreak Summary Report

For CNPHI Users: Login to CNPHI and enter enteric or respiratory/vaccine preventable disease outbreak summary

For non-CNPHI Users: Please contact the local public health CNPHI writer, or download the forms and report directly to Epidemiology & Surveillance, Public Health, Manitoba Health.