Chickenpox Report Form
Chickenpox is required to be reported to Colorado Department of Public Health and Environment (CDPHE) or to your local public health agency within four (4) days. Shingles is not a reportable condition. All reported information is confidential and will be used only for public health purposes. For more information on chickenpox and additional resources, visit CDPHE's chickenpox webpage (https://cdphe.colorado.gov/diseases-a-to-z/chickenpox). If you have questions, email CDPHE_VPD@state.co.us.
*Reporters, please ask parents or patients for a rash description. Specifically if the rash was generalized (on more than one part of the body) and if vesicles (small fluid filled blisters) are present.
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Reporter information
Name of person completing form: *
Title:
Report date *
Datum
Name of reporting facility: *
Phone: *
Type of reporting facility:
Weiter
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Dieses Formular wurde bei State.co.us Executive Branch erstellt.

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