Personal and personal health information contained on this form is collected under the authority of the Health Protection and Promotion Act R.S.O. 1990, cH.7., s.5. This information is collected and used for the purposes of prevention and control of diseases through investigations, conducting risk assessments of suspected exposures and case management. Questions about this collection and use of information should be addressed to Durham Region Health Department, Manager, Health Information, Privacy and Security at 605 Rossland Rd E., P.O. Box 730, Whitby, ON L1N 0B2, (905) 668-7711.