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:

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

Updated Monday, December 09, 2013 at 09:42AM