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:

Instructions and frequently asked questions

Instructions

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

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

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Updated Monday, February 03, 2014 at 03:38PM