Indiana Department of Health Confidential Case Report Forms
D NOT Fax case report forms. Completed case report forms should be mailed to:
Office of Clinical Data and Research
Indiana Department of Health
2 N. Meridian St., 6-C
Indianapolis, IN 46204
Adult form (>13 years of age at time of diagnosis)
Pediatric form (<13 years of age at time of diagnosis)
Additional resources regarding reporting:
Microsoft Powerpoint Presentation
OR
PDF Version