Blastomycosis Report Forms
These report forms are used to report blastomycosis in humans or canines to the Minnesota Department of Health.
Download a print version of the forms:
- Blastomycosis Report Form (PDF: 28KB/1 page)
For human blastomycosis cases please fill out this supplemental form. Updated: 7/2013
- Veterinary Blastomycosis Report Form (PDF: 40KB/1 page)
For canine cases please fill out this supplemental veterinary form. Updated: 11/2013
- If you have questions regarding this form, please call 651-201-5414.
- This is a supplemental reporting form, a Yellow Card is also required.
- By fax to:
- Download a printable form.
- To receive a copy of these forms by mail please call 651-201-5414.