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Public Reportable Disease Form

2. 

4. Reno County Health Department Epidemiology Program
   209 W 2nd Ave | Hutchinson, KS 67501 | Tel: (620) 259-8450 | Fax: (620) 694-2905

   209 W 2nd Ave | Hutchinson, KS 67501 | Tel: (620) 259-8450 | Fax: (620) 694-2905

6. Public Reportable Disease Form

8. ***If this is a medical emergency, please call 911.***

   ***If this is a medical emergency, please call 911.***

10. First Name*

11. Last Name*

12. Phone:*

14. Type of Illness:*
    -- Select One --Food illnessWater illnessAnimal BiteBug BiteInfectious diseaseOther

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16. 1. Receive an email copy of this form.
17. Email address

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