Pertussis Reporting Form
This form can be used to report pertussis (Bordetella pertussis - whooping cough) to the Minnesota Department of Health.
- Pertussis Reporting Form (PDF)
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 formAfter 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: