Legionellosis Case Report Form
This form is used to report Legionellosis (Legionella spp.) to the Minnesota Department of Health.
On this page:
Form
Instructions and frequently asked questions
Diseases to report on these forms
Returning the completed form
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Form
Download a print version of the form:
- Legionellosis Case Report Form (PDF: 208KB/3 pages). Updated 2/2013
Instructions and frequently asked questions
Instructions
- Legionellosis Case Report Form Instructions (PDF: 230KB/16 pages)
Step-by-step instructions for filling out the Legionellosis Case Report Form. Updated 2/2013
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.
Diseases to report this form
- Reporting Legionellosis (Legionella spp.)
More information about reporting Legionellosis.
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
- By mail (please mark the envelope "confidential") to:
Order more forms
- Download a printable form.
- To receive a copy of this form by mail please call 651-201-5414.
