Medium

Available on

Apple Android Windows

Reportable Disease Form Mobile App

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and is intended for use by health professionals only. Reportable Diseases and Conditions for specific diseases and conditions are mandated by state laws and regulations to be reported by healthcare providers and laboratories to local health officers. The Reportable Disease Form mobile app provides an easy to complete paperless version of the mandated case report form specific to all Reportable Communicable Diseases. The app is filled out using a smartphone or tablet. This GoCanvas app can be made HIPAA compliant and is ideal for Disease Surveillance and Reporting.

The Center for Disease Control, national centers, children’s hospital, public health and local health departments urge health care providers to promptly report infectious diseases as well as virus infections. It is important for patient safety. Pregnant women, immigrant children, illegal immigrants and travelers are at a greater risk for communicable diseases and birth defects from lack of infection control and virus transmission. This app is specific to all Reportable Communicable Diseases but please don’t hesitate to report any suspicious respiratory illness, flu, rash, pneumonia or virus infection. Timely reporting can stop outbreaks.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Reportable Disease Form Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    Disease Name

  • Ico textbox

    Patient’s Last Name First M.

  • Ico date

    Date of Birth

  • Ico integer

    Age

  • Ico dropdown

    Gender

  • Ico integer

    Address

  • Ico textbox

    City

  • Ico dropdown

    State

  • Ico integer

    Zip

  • Ico textbox

    County of Residence

  • Ico textbox

    Phone Number

  • Ico textbox

    Patient ID Number

  • Ico dropdown

    Ethnic Origin

  • Ico dropdown

    Race

  • Ico textbox

    Disease/Organism

  • Ico date

    Date of Onset

  • Ico date

    Date of Diagnosis

  • Ico multiline

    List Symptoms/Comments

  • Ico decimal

    Highest Temperature

  • Ico integer

    Days of Diarrhea

  • Ico dropdown

    Hospitalized?

  • Ico date

    Admission Date

  • Ico date

    Discharge Date

  • Ico dropdown

    Died?

  • Ico date

    Date of Death

  • Ico textbox

    Hospital Name:

  • Ico dropdown

    Is Patient Pregnant?

  • Ico integer

    If yes, # wks

  • ...and More!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

Confidential Morbidity Report (CMR)

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Creutzfeldt-Jakob Disease (CJD) and T...

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Reportable Disease Report

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Zika Virus Disease Case Investigation...

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Brucellosis Case Report California CD...

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Botulism Case Report California CDPH ...

The Botulism Case Report California CDPH 8547 mobile app makes it easy to track important details when a diagnosis of botu...

App Name

Ehrlichiosis/Anaplasmosis Case Repor...

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

App Name

Listeriosis Case Report California CD...

The Center for Infectious Diseases, Division of Communicable Disease Control, requires the information within this app and...

More Information