Pertussis Reporting Form
This form can be used to report pertussis (Bordatella pertussis - whooping cough) 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:
- Pertussis Reporting Form (PDF: 37KB/2 pages) Updated 6/2010
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
- 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.
