Coronavirus Disease (COVID-19) is a disease caused by the newly emerged coronavirus SARS-CoV-2.

COVID-19 Case Report Form

The COVID-19 Case Report Formpdf icon collects key information on COVID-19 case-patients, including:

• Demographic, clinical, and epidemiologic characteristics
• Exposure and contact history
• Course of clinical illness and care received

CDC developed the case report form to standardize the reporting of information on COVID-19 cases. These data will help us:

• Better understand the virus and its impact on health outcomes
• Inform public health response to prevent further spread of SARS-CoV-2

Here are two additional resources to help reporting jurisdiction health departments complete the case report form:

Please note that the form, instructions, and data dictionary were updated on May 5, 2020. 

Information on Persons Under Investigation

CDC previously collected information on persons under investigation and cases of COVID-19 (using the same form).

We no longer collect information on persons under investigation. The only exception to this is if jurisdictions do not have the capacity to do their own testing and are sending specimens to CDC. 

How to Submit a Report on a Case

Healthcare providers who are concerned that a patient may have COVID-19 and want to report a case should contact their localexternal icon or stateexternal icon health department immediately.

Jurisdictions that are not sending samples to CDC for laboratory testing

The jurisdiction should enter cases into CDC’s electronic reporting system with the jurisdiction-issued nCoV ID, unless other arrangements to transmit data have been approved by CDC.

Jurisdictions that are sending specimens to CDC for laboratory testing

This document provides supplemental guidance regarding specimen collection, storage, and shippingpdf icon to CDC laboratories. This is in addition to CDC’s guidelines for COVID-19 clinical specimens.

• Provide an nCoV ID with all specimens submitted to CDC
  • If an nCoV ID is missing, CDC laboratories will freeze the sample, and CDC staff will reach out to the point-of-contact listed on the submission form. CDC will test the specimen once the nCoV ID has been submitted.
  • Current CDC guidance recommends collection of a single respiratory nasopharyngeal (NP) swab.
• Include the nCoV ID on all Case Report Forms, specimen testing submission documents (i.e., form 50.34 or GFAT), and shipping labels

Source: https://tools.cdc.gov/api/embed/downloader/download.asp?m=403372&c=405410