Enteric (Foodborne) Disease Reporting Form
This form can be used to report amebiasis, campylobacteriosis, cryptosporidiosis, cyclosporiasis, E. coli infection (E. coli O157:H7, other Shiga toxin-producing enterohemorrhagic E. coli, enteropathogenic E. coli, enteroinvasive E. coli, enteroaggregative E. coli, enterotoxigenic E. coli, or other pathogenic E. coli), giardiasis, listeriosis, salmonellosis, shigellosis, trichinosis, vibrio, or yersiniosis to the Minnesota Department of Health.
Enteric Disease Reporting form
- Enteric Disease Reporting Form (PDF)
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.
Returning the completed formAfter 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 or 651-201-5082
Diseases to report with this form
- Amebiasis (Entamoeba histolytica/dispar)
- Campylobacteriosis (Campylobacter spp.)
- Cryptosporidiosis (Cryptosporidium spp.)
- Cyclosporiasis (Cyclospora spp.)
- Diphyllobothrium latum infection
- Enteric Escherichia coli Infection
- Giardiasis (Giardia intestinalis)
- Listeriosis (Listeria monocytogenes)
- Salmonellosis, including typhoid (Salmonella spp.)
- Shigellosis (Shigella spp.)
- Trichinosis (Trichinella spiralis)
- Vibrio spp.
- Yersiniosis (Yersinia species)