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

  • CDC Adult HIV Confidential Case Report Form (PDF)
    Revised 2018

  • CDC Pediatric HIV Confidential Case Report Form (PDF)
    Revised 2018

  • 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 CDC HIV Adult Confidential Case Report Form must be submitted.

Frequently asked questions

Returning the completed form

After filling out the form please mark "confidential" and return it to MDH:

  • by secure fax to:
    ATTN: HIV Surveillance Unit
    651-797-1972

  • 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 Monday, 24-Sep-2018 14:32:17 CDT