Invasive Methicillin-resistant Staphylococcus aureus Infection Case Report Form
This form is used for sentinel surveillance reporting of Invasive Methicillin-resistant Staphylococcus aureus in Hennepin and Ramsey Counties from selected sites to the Minnesota Department of Health.
on this page:
Form
Frequently asked questions
Diseases to report on this form
Returning the completed form
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Form
Download a print version of the form:
- Invasive Methicillin-Resistance Staphylococcus aureus Active Bacterial Core Surveilliance Case Report Form PDF: 1,410KB/ 2 pages)
Updated 3/15/2011.
Frequently asked questions
- Invasive MRSA Case Report Form Instructions (PDF: 297KB/56 pages)
Step-by-step instructions for filling out the Invasive MRSA Case Report Form.
- If you have additional 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 forms
- After filling out this form, please return it 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:
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- Download a printable form.
- To receive a copy of this form by mail please call 651-201-5414.
