Minnesota Confidential Syphilis Report Form

The Minnesota Confidential Syphilis Report Form is used to report lab confirmed cases of syphilis in Minnesota residents to the Minnesota Department of Health.

On this page:
Syphilis Report form
Frequently asked questions
Submitting completed forms
Diseases to report on this forms

Syphilis report form

The Minnesota Confidential Syphilis Report Form is used to report lab confirmed cases of syphilis in Minnesota residents to the Minnesota Department of Health.

• Minnesota Confidential Syphilis Report Form (PDF)

Frequently asked questions

• Frequently Asked Questions About STD and HIV Reporting
  
  
• If you have questions regarding the Minnesota Confidential Syphilis Report Form, please call 651-201-5414 or 877-676-5414.

Submitting completed forms

• When complete, fax the form to 1-800-298-3775.
  • No cover sheet is required.
• Forms may also be mailed (not necessary if faxed).
  • If mailing a form, please mark the envelope "confidential" and mail it to:
    MDH Infectious Disease Epidemiology, Prevention and Control,
    625 North Robert Street
    Post Office Box 64975
    St. Paul, MN 55164-0975

Diseases to report on this form

• Syphilis

See also: HIV/AIDS Confidential Case Report Forms