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.

On this page:
Enteric Disease Reporting form
Frequently asked questions
Returning the completed form
Diseases to report on this form

Enteric Disease Reporting form

• Enteric Disease Reporting Form (PDF)
  Updated 10/2017
  

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

• 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:
  1-800-233-1817

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)