Arboviral Disease Case Report Form - Minnesota Dept. of Health

Arboviral Disease Case Report Form

This form can be used to report West Nile, La Crosse encephalitis (or other California serogrup), Western equine encephalitis, Eastern equine encephalitis, St. Louis encephalitis, Powassan virus, or other arboviral disease to the Minnesota Department of Health.

On this page:
Frequently asked questions
Diseases to report on this form
Returning the completed form
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Download a print version of the form:

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.
    yellow card

Diseases to report this form

Returning the completed form

  • After 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:

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Updated Wednesday, November 04, 2015 at 11:37AM