Legionellosis Case Report Form

This form is used to report Legionellosis (Legionella spp.) to the Minnesota Department of Health.

On this page:
Legionella form & instructions
Frequently asked questions
Returning the completed form
Diseases to report on these forms

Legionella form & instructions

• Legionellosis Active Bacterial Core Surveillance (ABCs) Case Report Form (PDF)
  Updated 5/2015

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

After filling out this form, please return to MDH:

• 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

• Reporting Legionellosis (Legionella spp.)

More about this disease

• Legionellosis (Legionella): Legionnaires' Disease and Pontiac Fever