How to Fill Out and Submit the CMR Form (CDPH 110a)

The Confidential Morbidity Report, CDPH 110a, is a two-sided form you complete with the patient’s demographic details, the diagnosis and relevant clinical dates, and your own contact information as the reporting provider, then send to the local health officer in the county where the patient lives within the timeframe assigned to that specific disease. Use it for most reportable communicable diseases in California. Do not use it for tuberculosis, HIV/AIDS, or conditions reportable to the DMV, each of which has its own dedicated form.¹

Confirm CDPH 110a Is the Right Form

The standard CDPH 110a covers the bulk of reportable communicable diseases, including sexually transmitted infections and viral hepatitis, both of which have dedicated supplemental sections built into the form itself. Three categories go on different forms: tuberculosis uses a dedicated TB CMR, HIV infection uses the HIV-specific reporting process on a seven-calendar-day timeline, and disorders characterized by lapses of consciousness go on the CMR (DMV) under Health and Safety Code Section 103900.²

Download the current CDPH 110a from the CDPH website or from your county health department’s disease reporting page. Many counties post fillable PDFs and condition-specific supplements.³

Patient Information

The top of the form captures who the patient is and how investigators can reach them. Enter the full legal name as last, first, middle initial. Add the complete home address including apartment or unit number, and every phone number you have on file: home, cell, and work. Public health staff rely on these numbers to begin contact tracing, so missing digits here translate directly into delayed follow-up.

Record the date of birth in month/day/year format along with the patient’s age. The form asks for current gender identity, sex assigned at birth, and sexual orientation as separate items. Note pregnancy status and the estimated delivery date if applicable. Finish the block with country of birth, ethnicity, race, and primary language.¹

Diagnosis and Clinical Details

Write the disease name exactly as it appears on the reportable conditions list printed on the back of the form. Matching that wording keeps your report from being miscoded. Fill in the date of symptom onset, the date the first specimen was collected, the date of diagnosis, and the date of death if the patient has died. Describe clinical manifestations in the space provided.

The occupational and exposure setting section asks whether the patient works in food service, day care, healthcare, a correctional facility, or a school. Answer this accurately. Each setting changes how quickly and how broadly health investigators have to work.¹

If You’re Reporting an STI

The form includes supplemental STI fields. For syphilis, record the stage and serologic test results: RPR, VDRL, FTA-ABS, TP-PA, EIA/CLIA, and CSF-VDRL. For gonorrhea, note specimen sources and symptoms. Record the gender of sex partners, treatment details including drug name, dosage, and route, and whether partners were treated.

If You’re Reporting Viral Hepatitis

The hepatitis section captures the specific diagnosis (A, B, C, acute or chronic), whether the patient is symptomatic, a full panel of hepatitis serologic markers, suspected exposure types, and liver enzyme levels.

Reporter Information

The bottom of the form identifies you. Enter the reporting healthcare provider’s name, address, telephone number, fax number, and email address. Add the name of the reporting facility. If a laboratory confirmed the diagnosis, include the lab’s name along with its city, state, and ZIP code. Sign the form and date it. If someone other than the reporting provider actually completed the form, note that person’s name as well. An incomplete phone number or missing email in this block is the single most common reason follow-up calls from the health department go unanswered during an outbreak.

Know Your Deadline Before You Submit

The urgency category for the condition you are reporting is printed on the back of the form next to the disease name. Check it before you decide how to send the completed CMR.

Immediate Phone Call

The most dangerous conditions require an immediate telephone report to the local health officer, with the paper CMR following. This tier includes anthrax, botulism, cholera, diphtheria, measles, plague, rabies, tularemia, viral hemorrhagic fevers such as Ebola, Marburg, and Lassa, novel coronavirus infections, and any novel virus with pandemic potential. Any unusual disease occurrence or outbreak, even of a condition not individually listed, also requires an immediate phone call.⁴

One Working Day

A larger group of conditions must be reported within one working day of identification by fax, phone, or electronic submission. This tier includes pertussis, hepatitis A, salmonellosis, syphilis, shigellosis, legionellosis, malaria, West Nile virus, shiga toxin-producing E. coli, and COVID-19 hospitalizations, among others.⁴

Submitting the Completed Form

Every CMR goes to the local health officer in the county where the patient lives, not to the state CDPH. Sending it to Sacramento instead delays the investigation. If you do not know the patient’s home address, send the report to the health officer in the jurisdiction where you practice.⁵

Fax or Mail

The traditional route is a secure fax to the county health department’s confidential reporting line or a mailed hard copy to the communicable disease program. Each county publishes its fax number and mailing address on its public health reporting page. Some counties are phasing fax out. Santa Clara County, for example, has said PDF CMR forms will be accepted by fax only until June 1, 2026, after which providers must use its online web form.⁶

CalREDIE Provider Portal

The California Reportable Disease Information Exchange (CalREDIE) lets providers submit CMRs electronically to the local health department. To get access, submit a Reporter/Provider Account Request Form to your LHD. Once staff approve it, CalREDIE Help creates your account and sends login credentials.⁷

Electronic Case Reporting

Health systems with compatible electronic health records can use CalREDIE’s eCR module, which generates and transmits case reports automatically when a provider enters a reportable diagnosis.⁸

Whichever method you use, keep a copy of every CMR you file. You may need to produce it during a compliance audit or when investigators call with follow-up questions.

What Failing to File Costs You

Title 17, Section 2500 of the California Code of Regulations requires every healthcare provider who knows of or is treating a case or suspected case of a reportable disease to file a CMR with the local health officer where the patient lives.⁹ The definition of healthcare provider is broad: physicians, surgeons, veterinarians, podiatrists, nurse practitioners, physician assistants, registered nurses, nurse midwives, school nurses, infection control practitioners, dentists, medical examiners, and coroners all carry the obligation.⁴

Under Health and Safety Code Section 120295, violating the reporting requirements is a misdemeanor punishable by a fine of $50 to $1,000, up to 90 days in jail, or both. Each day the violation continues counts as a separate offense, so a week-long delay on a reportable diagnosis translates into seven separate misdemeanor charges.¹⁰

The CMR form itself also warns that failure to report is a citable offense under the Medical Board of California’s Citation and Fine Program, governed by Title 16, CCR, Sections 1364.10 and 1364.11.¹ The Medical Board can investigate and discipline a physician’s license independently of any criminal case, with sanctions ranging from fines and probation to suspension or revocation.

1
California Department of Public Health. Confidential Morbidity Report – CDPH 110a
2
California Legislative Information. California Code Health and Safety Code 103900 – Disorders Characterized By Lapses Of Consciousness
3
California Department of Public Health. Public Health Reporting
4
California Department of Public Health. Title 17, California Code of Regulations – Reportable Diseases and Conditions
5
Orange County California – Health Care Agency. Reporting Diseases
6
County of Santa Clara Public Health Department. Reportable Diseases and Conditions
7
California Department of Public Health. CalREDIE Provider Portal
8
California Department of Public Health. CalREDIE eCR
9
Cornell Law Institute. California Code of Regulations Title 17 Section 2500 – Reporting to the Local Health Authority
10
California Legislative Information. California Health and Safety Code 120295