Blastomycosis Report Forms
These report forms are used to report blastomycosis in humans or canines to the Minnesota Department of Health.
On this page:
Forms
Frequently asked questions
Diseases to report on these forms
Returning the completed forms
Order more forms
Forms
Download a print version of the forms:
- Blastomycosis Report Form (PDF: 21KB/4 pages)
For human blastomycosis cases please fill out this supplemental form. Updated: 12/2005
- Veterinary Blastomycosis Report Form (PDF: 32KB/3 pages)
For canine cases please fill out this supplemental veterinary form. Updated: 12/2005
Frequently asked questions
- If you have questions regarding this form, please call 651-201-5414.
- This is a supplemental reporting form, a Yellow Card is also required.
Diseases to report these forms
Returning the completed forms
After filling out this form, please return to MDH:- By fax to:
651-201-5730
Order more forms
- Download a printable form.
- To receive a copy of these forms by mail please call 651-201-5414.
