Minnesota Confidential Chlamydia and Gonorrhea Report Form

The Minnesota Chlamydia and Gonorrhea Report Form is used to report lab confirmed cases of chlamydia, gonorrhea in Minnesota residents to the Minnesota Department of Health.

On this page:
Chlamydia and Gonorrhea form
Frequently asked questions 
Submitting completed forms
Diseases to report on these forms
 

Chlamydia and Gonorrhea form

The Minnesota Confidential Chlamydia and Gonorrhea Report Form is used to report lab confirmed cases of chlamydia and gonorrhea in Minnesota residents to the Minnesota Department of Health.

• Minnesota Confidential Chlamydia and Gonorrhea Report Form (PDF)

Frequently asked questions

• Frequently Asked Questions About STD and HIV Reporting
   
• If you have questions regarding the Minnesota Chlamydia and Gonorrhea 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

• Chlamydia trachomatis infection 
   
• Gonorrhea (Neisseria gonorrhoeae)

Lymphogranuloma Venereum (LGV)

• Reporting LGV (PDF)
  This document includes testing and reporting information for Lymphogranuloma Venereum (LGV), a reportable type of Chlamydia trachomatis.

See also: HIV/AIDS Confidential Case Report Forms
See also: Syphilis Confidential Case Report Form