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INFECTIOUS DISEASES ACT
(CHAPTER 137)
MD 131
Regulation 3
INFECTIOUS DISEASES (NOTIFICATION OF INFECTIOUS DISEASES) REGULATIONS
NOTIFICATION OF INFECTIOUS DISEASES UNDER SECTION 6
PARTICULARS OF PATIENT (Please  appropriate box where applicable)
NRIC No./Passport No./Foreign Identification Number (FIN)
Name of Patient (BLOCK LETTERS)
Gender
Date of Birth (dd/mm/yyyy)
Ethnic Group
Residential Status
Male
Chinese
Indian
Resident
Female
Malay
Others
Non-Resident
Residential Address
Occupation
Telephone No.
Postal Code
Home
Place of Work/School/Child Care Centre/Kindergarten
Postal Code
Office/HP
DISEASES TO BE NOTIFIED FAX Nos : 62215528 or 62215538 or 62215567
E‐notification system is available at https://www.cdlens.moh.gov.sg
NOT LATER THAN 72 HOURS FROM TIME OF DIAGNOSIS
NOT LATER THAN 24 HOURS FROM TIME OF DIAGNOSIS
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Avian Influenza
 Acute Hepatitis A #
 Chlamydial Genital Infection *
Botulism
 Acute Hepatitis B #^
 Genital Herpes (first episode)*
Chikungunya Fever
 Acute Hepatitis C^
 Gonorrhoea*
Cholera
 Acute Hepatitis E
 Non‐Gonococcal Urethritis*
Dengue Fever
 Campylobacteriosis
 Syphilis ‐ Infectious Dengue Haemorrhagic Fever
 Diphtheria#
(primary/secondary)*
Ebola Virus Disease (EVD)
 Haemophilius Influenzae Type b (Hib)  Syphilis ‐ Non‐infectious Hand, Foot and Mouth Disease
Disease #
(latent/tertiary)*
Japanese Encephalitis
 HIV Infection
 Syphilis – congenital*
Legionellosis
 Leprosy
For sexually transmitted infections marked *, Leptospirosis
 Mumps#
full name, NRIC/Passport No./FIN, address and Malaria
 Pertussis#
telephone number need not be completed. Measles#
 Pneumococcal Disease (Invasive)#
Initials, date of birth, ethnic group and Melioidosis
 Salmonellosis
residential status of the patient should be Meningococcal Disease
 Tetanus
given
Middle East Respiratory Syndrome Coronavirus Infections (MERS‐CoV)
^ For notifiable diseases marked ^, please  Circle as appropriate
 Murine Typhus
provide serological/virus test results, Only laboratories are required to notify  Nipah Virus Infection
symptoms and recent ALT levels in the Chlamydial Genital Infections  Paratyphoid
“Remarks” box
 Plague
 Poliomyelitis#
 Rabies
FOR TB Please use Notification of Tuberculosis Form (MD532) to notify MOH not later than  Rubella#
72 hours from the time of diagnosis  Severe Acute Respiratory Syndrome (SARS)
 Report other diseases or clusters that may present significant risk to human
 Typhoid
health under the category ‘other significant disease’
 Yellow Fever
 Zika Virus Infection
  Other significant disease ____________________________________________
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# For notifiable diseases marked #, please provide vaccination history :
Yes - If yes, Date of vaccination (dd/mm/yyyy)
No
Travel history over the past one month
From (dd/mm/yyyy)
Diagnosis
Clinical
Confirmed by laboratory tests
Date present diagnosis was made/ suspected
For laboratory notification, please provide the
date of test of positive sample
Countries visited : ………………………………
to
Date of onset of illness
(dd/mm/yyyy, for laboratory
notification, please provide the
date of receipt of sample)
(dd/mm/yyyy)
Follow-up of patient.
Treated as outpatient
Referred to Communicable Disease Centre
Referred to DSC / TBCU
Hospitalised
Death
Others (specify) ……………………...
PARTICULARS OF INFORMANT
Name of Medical Practitioner/Scientist (BLOCK LETTERS)
Name and Address of Clinic/Hospital/Institution/Laboratory
Signature and Date
Postal Code
Physician Code (MCR No.)
Telephone Number
Remarks :
28.09.2016