How to Fill Out and Submit Kentucky’s Reportable Disease Form (EPID 200)

The Kentucky EPID 200 form is the single-page, double-sided paper report that physicians, nurses, labs, and healthcare facilities use to notify public health authorities of a reportable disease or condition. You fill in patient demographics, clinical findings, lab results, treatment, and your own contact information, then send it to the local health department or the Kentucky Department for Public Health by phone-plus-fax, fax, mail, or electronic submission, depending on how urgent the condition is. A blank copy of the July 2024 revision is available on the Kentucky Cabinet for Health and Family Services website.¹

Find Your Deadline Before You Fill Anything Out

The disease determines the deadline, and the deadline determines whether you can simply fax the form or need to pick up the phone first. Regulation 902 KAR 2:020 sorts reportable conditions into five notification tiers.²

Immediate: call the local health department right away, then follow up with an electronic or fax submission of the EPID 200 within one business day. This tier covers suspected bioterrorism, select agent testing submissions, outbreaks causing multiple hospitalizations or deaths, and newly recognized or emerging pathogens.
Urgent, within 24 hours: submit electronically, by fax, or by telephone to the local health department. If you call it in, send the written form by fax or electronic submission within one business day. Anthrax, botulism, measles, plague, rabies, and viral hemorrhagic fevers sit here.
Priority, within 1 business day: submit electronically, by fax, or by telephone (with the same written follow-up rule). Campylobacteriosis, pertussis, mumps, legionellosis, acute hepatitis B, West Nile virus disease, E. coli O157:H7, listeriosis, and foodborne outbreaks are in this tier.
Routine, within 5 business days: submit electronically, by fax, or by mail to the Kentucky Department for Public Health or the local health department. A few conditions in this tier must go directly to the state rather than the local office.
General, within 3 months: submit electronically, by fax, or by mail. Section 19 of the regulation lists the conditions.

For the two fastest tiers, the phone call is the report; the EPID 200 confirms it in writing. For routine and general conditions, the form alone is enough. The current reference list of which disease falls into which tier is published by the Kentucky Health Information Exchange.³

Filling Out the Form Section by Section

Pull the patient’s chart and the lab report before you start. Working from both at once prevents the gaps that trigger follow-up calls from state investigators.

Patient Demographics

Enter last name, first name, and middle initial, then street address, city, state, ZIP code, and county of residence. The county field controls which local health department receives the report, so get it right. Add the patient’s phone number, date of birth, sex assigned at birth, and current gender identity, then mark ethnic origin (Hispanic or non-Hispanic) and race.¹

Occupation, Setting, and Exposure Risk

Record the patient’s occupation and employer. Mark whether the patient lives in a congregate setting such as a nursing home, correctional facility, shelter, or other group residence, and if yes, select the facility type and give its name. Separate checkboxes identify school or daycare attendees, school or daycare workers, food handlers, and healthcare workers. These fields flag the cases where a single infection could reach a classroom, a cafeteria, or a nursing unit.¹

Clinical Information

Enter the disease or organism name, the date of symptom onset, and the date of diagnosis. List observed symptoms, highest recorded temperature, and, for gastrointestinal cases, the number of days of diarrhea. Mark whether the patient was hospitalized and give the admission date, discharge date, and hospital name. Record whether the patient died and the date of death. If the patient is pregnant, check “Yes” and note the estimated due date. Indicate any travel to or arrival from another state or country within the past 30 days, with details.¹

Laboratory Information

For each test, record the specimen collection date, the type of test, the laboratory name, the specimen source, and the result. The form has space for multiple test entries, which matters when confirmatory testing follows a screen. Mark whether the case is outbreak-associated.¹

Treatment and STD-Specific Fields

Record the treatment date, medication name, and dose. For sexually transmitted disease cases, additional sections capture disease staging (primary, secondary, early latent, late latent, or congenital syphilis), infection site for gonorrhea or chlamydia, and antibiotic resistance information. If the patient received prior treatment for the same syphilis infection, note the approximate date and location.

Reporter Information

At the bottom, write the name of the person completing the report, a phone number, and the name and address of the reporting facility. State investigators call this number when they need to verify a detail or expand an investigation, so legibility matters as much as the clinical content above it.

Where to Send the Completed Form

For most diseases, submit the EPID 200 to the local health department serving the county where the patient lives. Match the submission method to the tier: phone first for immediate and urgent cases (then written follow-up); electronic, fax, or phone for priority (then written follow-up if you called); electronic, fax, or mail for routine and general.²

STD reports go to a different address. Fax the completed form to the STD Prevention and Control Program at 502-564-5715, or mail it to:

Kentucky Department for Public Health
STD Prevention and Control Program
275 E Main St, MS: HS2CC
Frankfort, KY 40621¹

To reach the Department for Public Health directly, the statewide reporting line is 502-564-3418 or toll-free at 888-9REPORT (888-973-7678). The secure fax number is 502-696-3803. Facilities with access can also report through the state’s National Electronic Disease Surveillance System (NEDSS), which puts the case into state tracking fastest.¹

Who Has to File

KRS 214.010 requires every physician and advanced practice registered nurse to notify the local health department of a reportable disease or condition. Regulation 902 KAR 2:020 extends the duty to any professional licensed under KRS Chapters 311 through 314, which includes physicians, dentists, nurses, and other clinical practitioners. Laboratories carry an independent duty: any test result indicating infection with a reportable agent must be reported to the state or local health department where the patient lives, whether or not a clinician has made a formal diagnosis. When a specimen is sent to a national reference lab, the referring lab director, health facility, or ordering professional is responsible for making sure the result gets reported back.²

A healthcare facility can designate one person to report on behalf of its lab, pharmacy, and clinical units, and a single facility report for a condition diagnosed in its own lab satisfies both obligations.²

HIPAA Does Not Block the Report

Filing an EPID 200 without the patient’s authorization is permitted. The HIPAA Privacy Rule at 45 CFR 164.512(b) allows covered entities to disclose protected health information to a public health authority authorized by law to receive it for preventing or controlling disease.⁴ Kentucky’s mandate under KRS 214.010 and 902 KAR 2:020 is exactly the state law this exception contemplates. Use the department’s secure fax line rather than an unsecured one, and only email the form if your facility’s system meets the department’s electronic submission standards. Keep a copy per your facility’s medical records retention policy.

What Happens If You Don’t Report

KRS 214.990 sets penalties for violations of Chapter 214, which includes the reporting rules.⁵ A licensed professional who fails to report can also face disciplinary action from the relevant licensing board. The faster consequence is operational: a late report stalls contact tracing and outbreak response, and if the reporter listed on the form can’t be reached, the follow-up investigation stalls with it. Accurate reporter contact information is as much a part of a usable EPID 200 as the clinical fields above it.

1
Kentucky Cabinet for Health and Family Services. Kentucky Reportable Disease Form EPID 200
2
Kentucky Legislative Research Commission. 902 KAR 2:020 – Reportable Disease Surveillance
3
Kentucky Health Information Exchange. Table of Reportable Diseases and Conditions in Kentucky
4
eCFR. 45 CFR 164.512
5
Justia. Kentucky Code Chapter 214 – Diseases