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FORM 2
PREVENTION AND CONTROL OF DISEASE ORDINANCE
(Cap. 599)
Notification of Infectious Diseases other than Tuberculosis
Particulars of Infected Person

Name in English:	Name in Chinese:	Age / Sex:	I.D. Card / Passport No.:
Residential address:			Telephone No. (Home) : (Mobile) : (Office / school / others):
Name and address of workplace / school:
Job title / Class attended:
Hospital / Clinic sent to (if any):			Hospital / A&E No.:

Disease [""] below Suspected/Confirmed on _______ / _______ / ________ (Date: dd/mm/yyyy)

Acute poliomyelitis	Haemophilus influenzae type b infection (invasive)	Relapsing fever
Amoebic dysentery	Hantavirus infection	Rubella and congenital rubella syndrome
Anthrax	Invasive pneumococcal disease	Scarlet fever
Bacillary dysentery	Japanese encephalitis	Severe Acute Respiratory Syndrome
Botulism	Legionnaires' disease	Shiga toxin-producing Escherichia coli infection
Chickenpox	Leprosy	Smallpox
Chikungunya fever	Leptospirosis	Streptococcus suis infection
Cholera	Listeriosis	Tetanus
Community-associated methicillin-resistant Staphylococcus aureus infection	Malaria	Typhoid fever
Coronavirus disease 2019 (COVID-19)	Measles	Typhus and other rickettsial diseases
Creutzfeldt-Jakob disease	Melioidosis	Viral haemorrhagic fever
Dengue fever	Meningococcal infection (invasive)	Viral hepatitis
Diphtheria	Middle East Respiratory Syndrome	West Nile Virus Infection
Enterovirus 71 infection	Mpox*	Whooping cough
Food poisoning	Mumps	Yellow fever
Number of persons known to be affected: _______ Place and district of consumption (e.g. “XX Restaurant in Mongkok”): __________________________________________ __________________________________________ Date of consumption: _________________________	Novel influenza A infection	Zika Virus Infection
	Paratyphoid fever
	Plague
	Psittacosis
	Q fever
	Rabies

* Corresponding to monkeypox as specified in Schedule 1 under Cap. 599.

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Notified under the Prevention and Control of Disease Regulation by

Dr. ______________________________ of ___________________________Hospital / Clinic / Private Practice

(Full Name in BLOCK Letters)

_________________________Ward / Unit / Specialty on ______ / _______ / ________ (Date: dd/mm/yyyy)

Telephone No.: _______________ Fax No.: _______________ (Signature) ___________________

Remarks:

DH 1(s)(Rev. Sep 2023)