Foodborne (Enteric) Disease Reporting Form - Minnesota Dept. of Health

Foodborne (Enteric) Disease Reporting Form

This form can be used to report amebiasis, campylobacteriosis, cryptosporidiosis, cyclosporiasis, E. coli infection (E. coli O157:H7, other Shiga toxin-producing enterohemorrhagic E. coli, enteropathogenic E. coli, enteroinvasive E. coli, enteroaggregative E. coli, enterotoxigenic E. coli, or other pathogenic E. coli), giardiasis, listeriosis, salmonellosis, shigellosis, trichinosis, vibrio, or yersiniosis to the Minnesota Department of Health.

On this page:
Foodborne form
Frequently asked questions
Returning the completed form
Diseases to report on this form

Foodborne (Enteric) form

Frequently asked questions

  • If you have questions regarding this form, please call 651-201-5414.

  • When reporting on this form, a Yellow Card is not necessary.
    yellow card

Returning the completed form

After filling out this form, please return to MDH:
  • By mail (please mark the envelope "confidential") to:
    Infectious Disease Epidemiology, Prevention and Control
    625 North Robert Street
    Post Office Box 64975
    St. Paul, MN 55164-0975
  • By fax to:
    651-201-5743 or 651-201-5082

Diseases to report with this form

Updated Wednesday, 08-Feb-2017 08:02:29 CST