Report a Disease

Report a disease to the Sedgwick County Health Department Epidemiology Program using this form.

Patient
(required)
(required)







(required)
(required)
(required)
(required)
Parent/Guardian
Disease
(required)


Disease Specific Immunizations and Rash Information
Varicella



Laboratory Testing


Doctor/Clinic
Additional Information
If yes to any of the following, please provide details (e.g., estimated delivery date, child care facility name and address, travel history) in the Comments field.














School