Pertussis Reporting Form

This form can be used to report pertussis (Bordetella pertussis - whooping cough) to the Minnesota Department of Health.

On this page:
Pertussis form
Frequently asked questions
Returning the completed form
Diseases to report on this form

How to report pertussis disease

• Online using the REDCap Vaccine Preventable Disease (VPD) Reporting Form.
  This form can be used by health care providers, schools and child cares to report pertussis (whooping cough) to the Minnesota Department of Health.
• Other ways to report for health care providers.
  • By phone. Any reportable infectious disease may be reported by phone to MDH at 651-201-5414 or 877-676-5414.

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:
  1-800-295-9769

Diseases to report with this form

• Reporting Pertussis (Bordatella pertussis)

More about this disease

• Pertussis (Bordetella pertussis - whooping cough)