Arboviral Disease Case Report Form - Minnesota Dept. of Health

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.

On this page:
Arboviral form
Frequently asked questions
Returning the completed form
Diseases to report on this form

Arboviral 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
  • Please do not report Malaria on the arboviral report 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 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:
    651-201-5743

Diseases to report with this form

Updated Tuesday, 19-Sep-2017 08:59:31 CDT