Pertussis Reporting Form - Minnesota Dept. of Health

Pertussis Reporting Form

This form can be used to report pertussis (Bordatella pertussis - whooping cough) to the Minnesota Department of Health.

On this page:
Frequently asked questions
Diseases to report on this form
Returning the completed form
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Download a print version of the form:

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.
    yellow card

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:

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Updated Thursday, January 09, 2014 at 11:47AM