Reporting HIV/AIDS: Confidential Case Report Card - Minnesota Dept. of Health

HIV/AIDS Confidential Case Report Forms

This form is used to report cases of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) in Minnesota residents to the Minnesota Department of Health.

On this page:
HIV/AIDS forms
Frequently asked questions
Returning the completed forms
Diseases to report on these forms

HIV/AIDS forms

  • Adult HIV/AIDS Confidential Case Report Form (PDF)
    Revised 5/22/2015

  • Pediatric HIV/AIDS Confidential Case Report Form (PDF)
    Revised 4/5/2012

  • Perinatal HIV Report (PDF)
    Revised 9/1/2015
    • This report form must be completed a total of twice per patient, per pregnancy.
      Once when the clinician is made aware of the pregnancy (or if pregnant already, upon HIV diagnosis);
      and then again at the pregnancy outcome (birth, spontaneous abortion or induced abortion).
    • If a clinician is reporting a newly diagnosed patient (patient initially tested positive during a pregnancy) then both the Perinatal HIV Report Form and the Adult HIV/AIDS Confidential Report Form must be submitted.

Frequently asked questions

  • If you have questions regarding the HIV/AIDS Confidential Case Report form, please call 651-201-5414.

  • Submit only original forms to MDH - do not copy these forms.

  • Do not use the "yellow card" to report HIV/AIDS.
    no yellow card

Returning the completed form

After filling out this form please mark the envelope "confidential" and return it to MDH:
  • by mail (please mark the envelope "confidential") to:
    Minnesota Department of Health
    ATTN: HIV Surveillance Unit
    Infectious Disease Epidemiology, Prevention and Control
    625 North Robert Street
    Post Office Box 64975
    St. Paul, MN 55164-0975

  • Do not under any circumstances e-mail the completed form.

Diseases to report these forms

Updated Tuesday, 10-Jan-2017 12:00:46 CST