Arboviral Disease Case Report Form
This form can be used to report chikungunya virus disease, Eastern equine encephalitis, Jamestown Canyon virus disease, La Crosse encephalitis, Powassan virus disease, St. Louis encephalitis, West Nile virus, Western equine encephalitis, yellow fever, Zika virus disease and other arboviral diseases.
- Arboviral Disease Case Report Form (PDF)
Frequently asked questions
- If you have questions regarding this form, please call 651-201-5414.
- When reporting on this form, a Yellow Card is not necessary.
- Please do not report Malaria on the arboviral reprot form, use the disease-specific form:
Malaria Case Report Form
This form can be used to report Malaria (Plasmodium spp.) to the Minnesota Department of Health. Please report all patients (symptomatic or asymptomatic) who test positive for Plasmodium species.
Returning the completed formAfter filling out this form, please return to MDH:
- By mail (please mark the envelope "confidential") to:
Infectious Disease Epidemiology, Prevention and Control
625 North Robert Street
Post Office Box 64975
St. Paul, MN 55164-0975
- By fax to: