Minnesota Confidential Chlamydia and Gonorrhea Report Form - Minnesota Dept. of Health

Minnesota Confidential Chlamydia and Gonorrhea Report Form

The Minnesota Chlamydia and Gonorrhea Report Form is used to report lab confirmed cases of chlamydia, gonorrhea in Minnesota residents to the Minnesota Department of Health.

On this page:
Chlamydia and Gonorrhea form
Frequently asked questions
Submitting completed forms
Diseases to report on these forms

Chlamydia and Gonorrhea form

The Minnesota Confidential Chlamydia and Gonorrhea Report Form is used to report lab confirmed cases of chlamydia and gonorrhea in Minnesota residents to the Minnesota Department of Health.

Frequently asked questions

Submitting completed forms

  • When complete fax the form to 651-201-4040.
    • No cover sheet is required.
  • Forms may also be mailed (not necessary if faxed).
    • If mailing a form, please mark the envelope "confidential" and mail it to:
      MDH Infectious Disease Epidemiology, Prevention and Control,
      625 North Robert Street
      Post Office Box 64975
      St. Paul, MN 55164-0975

Diseases to report on this form

See also: HIV/AIDS Confidential Case Report Forms
See also: Syphilis Confidential Case Report Form

Updated Thursday, 19-Dec-2019 14:37:45 CST