Forms

• Surveillance proforma to be completed by Health Protection Units for cases of hepatitis B and acute hepatitis C (Word Document, 101 KB)
• Enhanced surveillance of acute hepatitis B - information sheet and sample referral form (PDF, 54 KB)
• Request form for: Issue of Hepatitis B Immunoglobulin for Infants at Risk of Hepatitis B Infection (Word Document, 48 KB)

Form for reporting cases of acute hepatitis A, acute hepatitis B and acute hepatitis C from GUM clinics to Health Protection Units, developed by LaRS hepatitis leads and the British Association of Sexual Health and HIV (BASHH). Please complete and return either form to your local Health Protection Unit via secure fax or post. A Directory of local Health Protection Units is on the HPA website.

• Form for reporting Hepatitis from GUM to HPUs – electronic version (Word Document, 96 KB)
• Form for reporting Hepatitis from GUM to HPUs – paper version (PDF, 41 KB)

If you have any comments on the form please contact: Catherine.Quigley@hpa.org.uk or Susie.Forster@hinchingbrooke.nhs.uk

The following form is for laboratories that wish to report on paper to CfI.

• Reporting form for laboratories for NEWLY identified Hepatitis B (PDF, 136 KB)