Minnesota Confidential STD Case Report Form
The Minnesota Confidential STD Case Report Form is used to report lab confirmed cases of chancroid, chlamydia, gonorrhea, and syphilis in Minnesota residents to the Minnesota Department of Health.
STD form & instructions
- Minnesota Confidential STD Case Report Form (PDF)
Revised effective July 1, 2013
Frequently asked questions
- If you have questions regarding the STD Case Report
Card, please call 651-201-5414 or 877-676-5414.
Asked Questions about STD Reporting
MDH fact sheet on STD reporting.
- Do not use the "yellow card" to report STDs.
- If the second page does not contain any information (no untreated partners or not a case of syphilis) it does not have to be submitted blank.
Submitting the completed STD Case Report Card
- When complete fax the form to 651-201-4040.
- No cover sheet is required.
- Forms may also be mailed (not necessary if faxed).
- If mailing a form, please mark the envelope
"confidential" and mail it to:
MDH Infectious Disease Epidemiology, Prevention and Control,
625 North Robert Street
Post Office Box 64975
St. Paul, MN 55164-0975
- If mailing a form, please mark the envelope "confidential" and mail it to:
Diseases to report on this form
- Chancroid (Haemophilus ducreyi)
- Chlamydia trachomatis infection
- Gonorrhea (Neisseria gonorrhoeae)