Last Updated: 04/25/2023
Blastomycosis Report Forms
These report forms are used to report blastomycosis in humans or animals to the Minnesota Department of Health.
- Endemic Fungal Disease Case Report Form (PDF)
For human blastomycosis cases please use this report form. Updated: 4/2023
- Animal Blastomycosis Report Form (PDF)
For animal cases please fill out this veterinary form. Updated: 11/2021
Frequently asked questions
- If you have questions regarding this form, please call 651-201-5414.
Returning the completed forms
After filling out this form, please return to MDH:
- By fax to: