Zika Pregnancy Registry and Birth Defects Surveillance Forms Zika Pregnancy Registry and Birth Defects Surveillance Forms

To understand more about Zika virus infection, CDC established the US Zika Pregnancy Registry and is collaborating with health departments to collect information about pregnancy and infant outcomes following laboratory evidence of Zika virus infection during pregnancy. The data collected through this registry will be used to update recommendations for clinical care, to plan for services for pregnant women and families affected by Zika virus, and to improve prevention of Zika virus infection during pregnancy. 

Below are links to the fillable PDF forms for the the U.S. Zika Pregnancy Registry.  Please read the instructions in the forms on how to submit forms to the CDC.

U.S. Zika Pregnancy Registry - Infant Follow-Up Form

U.S. Zika Pregnancy Registry and Birth Defects Surveillance — Integrated Maternal Health History Form

U.S. Zika Pregnancy Registry and Birth Defects Surveillance — Integrated Neonate Assessment Form

City of Chicago Zika Delivery Checklist for Providers (**updated 2/15/2017)

For additional questions, you may reach the Chicago Department of Public Health by calling the Zika response line: 312-746-4835 or email: zika@cityofchicago.org. You will receive a response within 24 during regular business hours (M-F 8am to 4:30pm).

For urgent matters, you may reach the Communicable Disease Physician on-call by calling 311 (or 312-744-5000 if outside the City of Chicago).