Varicella Reporting Form - Minnesota Dept. of Health

Varicella Reporting Form

This form can be used to report varicella (chickenpox) to the Minnesota Department of Health.

On this page:
Varicella report form
Frequently asked questions
Returning the completed form

Varicella report 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 fax to: 651-201-4820 (for vaccine-preventable diseases) or 651-201-5743 (for all reportable diseases)
  • By mail (please mark the envelope "confidential") to:
    Infectious Disease Epidemiology, Prevention and Control
    625 North Robert St.
    PO Box 64975
    St. Paul, MN 55164

More about this disease

Updated Tuesday, January 10, 2017 at 12:00PM