Tickborne Disease Case Report Form - Minnesota Dept. of Health

Tickborne Disease Case Report Form

This form can be used to report anaplasmosis, babesiosis, ehrlichiosis, Lyme disease, and spotted fever rickettsiosis (including typhus).

On this page:
Tickborne form
Frequently asked questions
Returning the completed form
Diseases to report on this form

Tickborne 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

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

Diseases to report with this form

Updated Tuesday, 10-Jan-2017 12:00:51 CST