Directions for completing form:
Please note: Completing this form will only register your intent to submit syndromic surveillance data. The Department of Health cannot bring all organizations in Pennsylvania into the syndromic surveillance system at this time. Registrants will be prioritized based on type of organization, geographic location, and number of anticipated reports. If your organization is selected to begin onboarding or be put into the onboarding queue, you will be contacted by the Department of Health or its syndromic surveillance system vendor to continue the process.