Vancomycin Intermediate and Vancomycin Resistant Staphylococcus aureus (VISA/VRSA) Case Report Form

There is also a supplemental reporting form for Vancomycin Intermediate and Vancomycin Resistant Staphylococcus aureus (VISA/VRSA).

Before filling out the VISA/VRSA Case Report Form, please call MDH at 651-201-5414 or 1-877-676-5414.

On this page:
VISA/VRSA Form
Frequently Asked Questions
Returning the Completed Form

VISA/VRSA Case Report Form

• Vancomycin Intermediate and Vancomycin Resistant Staphylococcus aureus (VISA/VRSA) Case Report Form (PDF)
  Updated 10/2015
  

Frequently Asked Questions

• Before filling out the VISA/VRSA Case Report Form, please call MDH at 651-201-5414 or 1-877-676-5414.
  
  
• When reporting on a VISA/VRSA Case Report Form, a Yellow Card is not necessary.
  

Returning the Completed VISA/VRSA Case Report Form

• Please return the completed form 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

• Reporting Staphylococcus aureus Infection

More about these diseases

• Staphylococcus aureus