Blastomycosis Report Forms
These report forms are used to report blastomycosis in humans or canines to the Minnesota Department of Health.
- Blastomycosis Report Form (PDF)
For human blastomycosis cases please fill out this supplemental form. Updated: 3/2016
- Veterinary Blastomycosis Report Form (PDF)
For canine cases please fill out this supplemental veterinary form. Updated: 3/2016
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 formsAfter filling out this form, please return to MDH:
- By fax to:
Order more forms
- To receive a copy of these forms by mail please call 651-201-5414.