HIV/AIDS Confidential Case Report Forms

This form is used to report cases of HIV/AIDS in Minnesota residents to the Minnesota Department of Health.

On this page:
Form
Diseases to report on this form
Questions
Returning the completed forms
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HIV/AIDS Confidential Case Report Form

The HIV reporting form has been updated. The form can be downloaded from this website as an interactive PDF file. You can fill it out and mail it to the Health Department.

Download the interactive print version of the forms:

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

Diseases to report on this form

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 (previously known as the "blue card") to report HIV/AIDS.
    Do not use the blue card graphic

Returning the Completed HIV/AIDS Confidential Case Report 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.

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Updated Thursday, 09-Jan-2014 11:47:16 CST