HIV/AIDS Confidential Case Report Forms

These forms are used to report cases of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) in Minnesota residents to the Minnesota Department of Health.

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

HIV/AIDS forms

• CDC Adult HIV Confidential Case Report Form (PDF)
  This form for reporting adult cases of HIV/AIDS to MDH.
  Revised 2023
• CDC Pediatric HIV Confidential Case Report Form (PDF)
  This form for reporting pediatric cases of HIV/AIDS to MDH.
  Revised 2023
• HIV Perinatal Report Form (PDF)
  This form is used to report pregnancy in a person chronically infected with HIV/AIDS to MDH. This form must be submitted during pregnancy and at pregnancy outcome.
  Revised 2023
  • CDC Perinatal HIV Exposure Report Form (PDF)
    This form is to report information on infants exposed to the HIV infection at delivery.
    Revised 2019
• Fillable versions of the CDC forms are available upon request from the HIV surveillance program.

Frequently asked questions

• Frequently Asked Questions About STD and HIV Reporting
• If you have questions regarding the HIV/AIDS Confidential Case Report form, please call 651-201-5414.

Returning the completed form

After filling out the form please mark "confidential" and return it to MDH:

• by secure fax to:
  ATTN: HIV Surveillance Unit
  1-800-318-8137
• by mail (please mark the envelope "confidential") to:
  Minnesota Department of Health
  ATTN: HIV Surveillance Unit
  Infectious Disease Epidemiology, Prevention and Control
  625 North Robert Street
  Post Office Box 64975
  St. Paul, MN 55164-0975
• Do not under any circumstances e-mail the completed form.

Diseases to report using these forms

• HIV, Including AIDS (lab-confirmed cases)