Tickborne Disease Case Report Form

This form can be used to report Lyme disease, Babesiosis, Human anaplasmosis, Human ehrlichiosis, Rocky Mountain spotted fever, and other tickborne disease 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:

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:
      651-201-5743

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Updated Thursday, 09-Jan-2014 11:47:28 CST