Neonatal Sepsis Surveillance Form - Minnesota Dept. of Health

Neonatal Sepsis Surveillance Forms

There are two forms that form can be used to report Neonatal Sepsis to the Minnesota Department of Health.

on this page:
Forms & instructions
Frequently asked questions
Diseases to report on this form
Returning the completed form
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Forms & instructions

Download a print version of the forms:

  1. Neonatal Sepsis Surveillance Form (PDF)
    Updated 2/2013
  2. Neonatal Sepsis Expanded Tracking Form (PDF)
    Updated 12/2013
  3. form
    • instructions

Frequently asked questions

  • If you have questions regarding these forms, please call 651-201-5414.

  • Use this form to report invasive bacterial disease cases, not the Yellow Card.

Diseases to report these forms

  • Neonatal sepsis, less than 7 days after birth, isolated from a sterile site in infants

Returning the completed forms

  • After filling out the Neonatal Sepsis Surveillance Form or the Neonatal Expanded Tracking Form, please fax it to 651-201-5743.

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Updated Monday, October 05, 2015 at 08:31AM