Minnesota Confidential Syphilis Report Form - Minnesota Dept. of Health

Minnesota Confidential Syphilis Report Form

The Minnesota Confidential Syphilis Report Form is used to report lab confirmed cases of syphilis in Minnesota residents to the Minnesota Department of Health.

On this page:
Syphilis Report form
Frequently asked questions
Submitting completed forms
Diseases to report on this forms

Syphilis report form

The Minnesota Confidential Syphilis Report Form is used to report lab confirmed cases of syphilis 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 14:42:34 CST