The NYC Universal Reporting Form (URF-0803) is the paper document New York City healthcare providers use to report notifiable diseases, conditions, and certain environmental events like animal bites and drownings to the Department of Health and Mental Hygiene (DOHMH). You can download the current version from the DOHMH website or skip the paper entirely by reporting through PRISM, the department’s online system. Most reports are due within 24 hours of diagnosis. A smaller group of rare or highly infectious diseases requires an immediate call to the Provider Access Line at 866-692-3641 before anything is written down.
When To Call Instead of Filing the Form
Some diagnoses are urgent enough that the DOHMH needs to hear about them by phone. If you suspect any of the following, call 866-692-3641 first and complete the written report through PRISM or fax afterward:
- Bioterrorism agents: anthrax, botulism, brucellosis, glanders, melioidosis, plague, Q fever, smallpox, tularemia, and staphylococcal enterotoxin B poisoning
- Viral hemorrhagic fevers: Ebola, Marburg, and Lassa fever
- Respiratory threats: MERS coronavirus, novel-strain influenza with pandemic potential, and diphtheria
- Other high-priority infections: cholera, measles, monkeypox (mpox), acute HIV infection, hantavirus pulmonary syndrome, and vaccinia virus
- Arboviruses: Eastern equine encephalitis, Powassan virus, and West Nile virus
- Carbon monoxide poisoning with carboxyhemoglobin at or above 10%
Outbreaks always trigger the phone requirement regardless of disease. That means any suspected cluster of three or more people, any unusual presentation of a known disease, or any newly emerging syndrome of uncertain cause.
There is one more trigger that catches providers off guard. Some conditions on the 24-hour list are marked with a dagger (†) on the DOHMH disease list. For those, you have to check whether the patient works in or attends a childcare facility, food service, healthcare facility, correctional institution, long-term care home, shelter, school, or dormitory. If they do, the condition escalates to immediate reporting. Missing that escalation is the single most consequential reporting error, because it delays the response exactly where speed matters.
Acute hepatitis B is another quiet exception: it’s normally a 24-hour condition, but if the only apparent risk factor is a medical procedure, report it immediately by phone.
What To Report Within 24 Hours
Everything else on the DOHMH’s notifiable list must reach the department within 24 hours of a confirmed diagnosis, through PRISM, mail, or fax. The conditions providers submit most often include:
- Sexually transmitted infections: chlamydia, gonorrhea, syphilis (all stages, including congenital), chancroid, granuloma inguinale, and lymphogranuloma venereum
- Hepatitis: acute hepatitis B, hepatitis B in a pregnant or postpartum woman, hepatitis B test results for infants born to positive mothers, and acute hepatitis C
- Tick-borne diseases: Lyme, anaplasmosis, babesiosis, ehrlichiosis, and Rocky Mountain spotted fever
- Gastrointestinal infections: campylobacteriosis, cryptosporidiosis, cyclosporiasis, giardiasis, and food poisoning involving two or more people
- Respiratory and vaccine-preventable: pertussis, mumps, varicella (not shingles), and legionellosis
- Tuberculosis: active TB, and latent TB in children younger than five
- Other infections: listeriosis, leptospirosis, malaria, invasive Group A and Group B streptococcal infections, bacterial meningitis, and invasive Haemophilus influenzae disease
Several non-infectious events use the same 24-hour window. Drownings go through PRISM. Falls from windows involving children 16 or younger in buildings with three or more units are reportable within 24 hours. Lead poisoning with blood lead levels at or above 3.5 micrograms per deciliter and suspected pesticide poisonings also belong on the form.
A few conditions don’t use the URF at all. HIV (non-acute) and AIDS diagnoses go on the New York State Provider Report Form within seven days — call 518-474-4284 for copies or 212-442-3388 for guidance. Animal bites use a separate online portal, within 24 hours. If you send any of these through the URF, expect them to be rerouted or returned for resubmission.
How To Fill Out the Form
The URF is a multi-page document organized by section. You won’t complete every field on every report. Fill in the patient block at the top, your reporter and facility block, and then only the disease-specific section that matches the diagnosis.
Patient Information
Start with the patient’s full legal name, any aliases, date of birth, age, and country of birth. Add a Social Security number if available, along with the medical record number and Medicaid number. Record the home address, borough, phone numbers, and email. If the patient is unhoused, mark the checkbox provided rather than leaving the address blank. For minors, include a guardian’s name.
Then record the clinical dates: date of diagnosis, date of illness onset, and date of the report. If the patient was hospitalized, add admission and discharge dates. Note whether the condition appears to involve healthcare-associated transmission. For patients 12 and older, gender identity and sexual orientation fields are optional and are used mainly for STI surveillance.
Reporter and Facility Information
Give your name, phone, fax, and email as the reporter. Add the facility name, street address, and National Provider Identifier (NPI) or Permit Facility Identifier (PFI). If the patient is being treated at a facility different from where you practice, fill in that facility’s information in its own block. The laboratory block takes the lab’s name, address, phone, and CLIA number.
Risk Group Assessment
For any disease marked with a dagger (†), complete the risk group section. This is where you check whether the patient works in or attends childcare, food service, healthcare, correctional, long-term care, shelter, school, or dormitory settings. A yes answer here changes the reporting timeline from 24 hours to immediate. Check this section carefully before you decide you have a routine report.
Disease-Specific Sections
The later pages are organized by disease category and ask for the clinical detail that surveillance teams need.
- Hepatitis asks for specific serological markers.
- Tuberculosis asks for AFB smear results, nucleic acid amplification results, culture data, imaging findings, and current treatment medications with dosages.
- STI sections cover partner notification status, PrEP or doxycycline post-exposure prophylaxis use, and treatment details including drug dosages for gonorrhea and chlamydia.
- Environmental sections cover animal bite details (species, breed, body area bitten, owner information), drowning circumstances, window fall details, and poisoning route and substance.
Record what you diagnosed and what you found. The form is a surveillance tool, not a clinical narrative.
How To Submit
Online Through PRISM
PRISM (Provider Reporting Interface and Secure Messenger) is DOHMH’s preferred method and, as of May 2025, replaced the older Reporting Central system. Log in at a816-health.nyc.gov/prism using a NYC.ID account. NYCMED credentials will not work; if you don’t have a NYC.ID, register for one at the city’s account portal first.
On your first login, complete the “My Profile” section with your facility, laboratory, and provider details. PRISM saves these and pre-populates them on later reports, which is a real time saver if you report regularly. Sessions time out after 60 minutes of inactivity. The system saves entered data before timing out, but long idle periods can still cost you work.
Print and mail the completed form to:
NYC Department of Health and Mental Hygiene
42-09 28th Street, CN-22
Long Island City, NY 11101
Mail is the slowest option and is only sensible for 24-hour conditions when PRISM is unavailable. Don’t use mail for anything immediately reportable; those still need a phone call.
Fax
Fax numbers vary by disease. Call the Provider Access Line at 866-692-3641 to get the right number for your report. The wrong fax number routes your form to the wrong surveillance team and delays processing.
Phone
For immediately reportable diseases, outbreaks, and unusual presentations, call 866-692-3641 or 347-396-7995. A DOHMH representative may ask you to follow up with a written report through PRISM or fax after the call.
After You Submit
If you reported through PRISM, you can download a PDF of your submission from the PRISM home page using the “Download PDF” button. You will need the record ID (the URF ID), the patient’s last name, and the patient’s date of birth. Only the user who originally submitted the report can download or correct it.
To fix an error, use the “Make a Correction” button on the PRISM home page with those same three identifiers. Corrections matter when lab results come back after the initial report or when a preliminary diagnosis changes; updating the record keeps surveillance data accurate and avoids unnecessary follow-up calls from DOHMH epidemiologists.
Mail and fax submissions don’t generate automatic confirmations. If you need to verify a paper report was received, call the Provider Access Line. Keep a copy of every submitted form in your own records; this is standard practice and may be required under your facility’s record retention policy.
Common Mistakes That Delay Processing
The most frequent error is sending in a written form for a condition that required an immediate phone call first. If the disease is on the immediate list, or if the risk-group dagger applies to your patient, the written form alone isn’t enough.
Incomplete patient demographics are the next most common problem. A missing date of birth, address, or borough makes it harder for DOHMH to match the report to existing case records or to run geographic analysis. If the patient genuinely has no fixed address, use the unhoused checkbox rather than leaving the field blank.
Finally, using the wrong form is a reliable way to create rework. HIV (non-acute) and AIDS belong on the New York State Provider Report Form. Window falls have their own dedicated form. Animal bites have a separate online portal. The URF covers a lot of territory, but not these.