The URF should be used to report all diseases and conditions previously reported on the 395V/VDH341 (Report of Communicable/Sexually Transmitted Diseases) and TB76 (for reporting Tuberculosis). These include:
- Communicable diseases as listed in the section
entitled 'Disease (code) with special instructions' (Pages 1 and 2 of the URF
- Poisoning cases as listed in the section
'Poisoning' (Page 2 of the URF)
- Sexually transmitted diseases as listed in the
section 'Sexually Transmitted Diseases' (Page 2 of the URF)
- Tuberculosis in section 'Tuberculosis' (Page 2 of the URF)
* Note: this form does not replace any other DOHMH forms (such as the IMM5 form for reporting hepatitis B in pregnant women or the CDC Malaria Case Surveillance Report)
To order more URFs, call the Provider Access Line at
1-866-NYC-DOH1 (allow 2 - 3 weeks for delivery).
or download and print a URF
► See instructions for completing the Electronic Universal Reporting Form (eURF)
Call DOHMH if there is an outbreak or suspected outbreak of any disease or condition, of known or unknown etiology, which may be a danger to public health, occurring in three or more persons or any unusual manifestation of a disease in an individual.
Call the Provider Access Line 1-866-NYC-DOH1 during business hours; after 5PM call the Poison Control Center at 1-800-222-1222.