Blastomycosis Report Forms

These report forms are used to report blastomycosis in humans or animals to the Minnesota Department of Health.

On this page:
Blastomycosis forms
Frequently asked questions
Returning the completed forms
Diseases to report on these forms

Blastomycosis forms

• 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:
  1-800-233-1817

Diseases to report these forms

• Reporting Blastomycosis (Blastomyces dermatitidis)