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Previous studies of underreporting of disease have mainly addressed the attitudes of physicians toward reporting of communicable disease to public health agencies and have not examined adequately the physicians' knowledge of the reporting system as a cause of underreporting. To investigate, the authors designed a questionnaire and distributed it to 345 physicians at two hospitals. One hundred and sixty-nine questionnaires, which examined knowledge of reporting requirements and reasons for not complying with those requirements during 1978-81, were returned (a 49 percent response rate). Most of the respondents knew that reporting is required, but their knowledge in specific areas, such as which diseases are reportable, varied greatly. The number of physicians who knew which diseases they are required to report ranged from a low of 63 physicians (37 percent) for trachoma to 163 (96 percent) for syphilis. Of the 169 physicians, only 50 believed they knew how to report reportable diseases, and only 40 of them knew the correct procedures. Thirty-six percent of the 169 physicians indicated that they had not reported any cases at all during 1978-81. On the average, physicians recalled reporting 28 percent of their reportable cases. When they indicated why they had not complied with reporting requirements, the physicians chose reasons that reflected a lack of knowledge of the reporting system. The most common reasons were "did not know how to report" and "did not know it was a reportable disease." The results suggest that a major factor in physician underreporting is a lack of knowledge of the morbidity reporting system.