Infectious Disease Reporting
- Infectious Disease Reporting Home
- Reportable Diseases
- Methods of Reporting
- Persons Required to Report
- Submitting Clinical Materials
- Reporting Rule
Related Topics
Contact Info
Infectious Disease Epidemiology, Prevention and Control Division
651-201-5414
Tickborne Disease Case Report Form
This form can be used to report anaplasmosis, babesiosis, ehrlichiosis, Lyme disease, and spotted fever rickettsiosis (including typhus).
On this page:
Tickborne form
Frequently asked questions
Returning the completed form
Diseases to report on this form
Tickborne form
- Tickborne Disease Case Report Form (PDF)
Updated 7/2012
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
- Lyme Disease (Borrelia burgdorferi, and other Borrelia spp.)
- Babesiosis (Babesia spp.)
- Anaplasmosis (Anaplasma phagocytophilum)
- Ehrlichiosis (Ehrlichia spp.)
- Spotted fever rickettsiosis (Rickettsia spp. infections, including Rocky Mountain spotted fever)
Last Updated: 10/05/2022