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)
  Clinics must use this form to report pregnant persons living with HIV/AIDS to MDH within one working day of knowledge of the pregnancy. This form is also used to report infants born to pregnant people living with HIV within 24 hours of birth. 
  Revised 2024
• 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)