0.5 CME. Many clinicians based diagnostic decisions on their assessment as to the likelihood that a patient has Lyme disease. Most consider epidemiologic data that is derived from surveillance case reports. However, this may underestimate risk for patients that reside in what has been considered traditionally low incidence states. This presentation documents the changing geographic demographics of the illness and clinicians in some areas of the country may need to reconsider how they assess a patient’s risk of Lyme disease.