Active Bacterial Core Surveillance (ABCs) Case Report Form - Minnesota Dept. of Health

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

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

  • To receive a copy of these forms by mail please call 651-201-5414.

Updated Tuesday, March 22, 2016 at 01:12PM