Varicella (Chickenpox) and Zoster (Shingles) Report Forms

On this page:
VPD Report Form
Frequently Asked Questions 
Diseases to report with this form
 

VPD report form

• Vaccine Preventable Disease (VPD) Reporting Form
  This form can be used by Health care providers, schools and child cares to report varicella (chickenpox) and shingles (zoster) to the MDH.

Other ways to report for schools and child care

• Varicella (Chickenpox) and Zoster (Shingles) Case Report Form for Minnesota Schools and Child Cares (PDF) 
  This form can be used by schools and child care to report cases of chickenpox or shingles by fax to 1-800-295-9769.

Other ways to report varicella for health care providers

• Varicella Report Form for Health Care Providers (PDF) 
  This form can be used by health care providers to report varicella (chickenpox) to the Minnesota Department of Health.
  Fax the completed form to 1-800-295-9769.

Frequently Asked Questions

• When reporting on one of the forms mentioned above, a Yellow Card is not necessary.
  
   
• Yellow Disease Report Card
  Zoster disease may be reported using the MDH "Yellow Card."

Diseases to report with this form

• Reporting Varicella (Chickenpox)
• Reporting Zoster (Shingles)