Neonatal Sepsis Surveillance Forms

These forms can be used to report Neonatal Sepsis to the Minnesota Department of Health.

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

Forms & instructions

1. CDC: Neonatal Sepsis Surveillance Form (PDF)
   • Neonatal Sepsis Form Instructions (PDF)
     Step-by-step instructions for filling out the Neonatal Sepsis Form.
2. CDC: Neonatal Sepsis Expanded Tracking Form (PDF)
   • Neonatal Sepsis Expanded Tracking Form Instructions (PDF)
     Step-by-step instructions for filling out the Neonatal Sepsis Expanded Tracking Form.

Frequently asked questions

• If you have questions regarding these forms, please call 651-201-5414.
   
• When using these forms a Yellow Card is not required.
  

Returning the completed forms

• After filling out the Neonatal Sepsis Surveillance Form or the Neonatal Expanded Tracking Form, please fax it to 1-800-233-1817.

Diseases to report with this form

• Reporting Neonatal sepsis, less than 7 days after birth

Other reporting:

• Haemophilus influenzae (Hi) Neonatal Sepsis Expanded Surveillance (HiNSES)
  Surveillance for Haemophilus influenzae (Hi) Neonatal Sepsis was expanded among neonatal, pregnant and post-partum patients effective January 1, 2016.

More about this disease

• Neonatal Sepsis