1. Reporter details

Per 7 AAC 27.017, health care providers are required to report patients with a disease, injury, or other condition of public health importance that is known or suspected to be a result of the person’s occupation or work activities to the Division of Public Health. Reports must be made within 5 working days of the date of diagnosis. Forms and definitions may be found at http://dhss.alaska.gov/dph/Epi/Pages/pubs/conditions/crforms.aspx .

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* Reporting Agency/Clinician

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* Agency phone number

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* Agency record number

 
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