Pertussis Reporting Form
This form can be used to report pertussis (Bordatella pertussis - whooping cough) to the Minnesota Department of Health.
On this page:
Pertussis form
Frequently asked questions
Returning the completed form
Diseases to report on this form
Pertussis form
- Pertussis Reporting Form (PDF)
Updated 6/2010
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 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
More about this disease
Spotlight
Clinical Materials
Guidelines for submitting clinical materials (isolates or material containing the infectious agent) to MDH.
Reportable Disease Poster
Printable list of reportable communicable diseases in Minnesota.
- Annual Summary of Disease Activity
Infectious disease surveillance information (statistics). - Antimicrobial Susceptibilities of Selected Pathogens
MDH antibiogram.
New (12/2019) syphilis and gonorrhea/chlamydia case report forms now available:
Minnesota Confidential Chlamydia and Gonorrhea Report Form
Minnesota Confidential Syphilis Report Form
Contact us:
If you have questions or comments about this page, use our IDEPC Comment Form or call 651-201-5414 for the MDH Infectious Disease Epidemiology, Prevention and Control Division.
