Haemophilus influenzae (Hi) Neonatal Sepsis Expanded Surveillance (HiSNES) Report Form

The HiNSES form is used for reporting Haemophilus influenzae (Hi) Neonatal Sepsis for expanded surveillance to the Minnesota Department of Health.

On this page:
HiSNES forms & instructions
Frequently asked questions
Returning the completed form
More about HiSNES surveillance
Diseases to report with this form

HiSNES forms & instructions

• HiSNES Report Form (PDF)
  Updated 1/2018
  • HiSNES Form Instructions (PDF)
    Step-by-step instructions for filling out the HiSNES Form. Updated 1/2018
  • ABCs Case Report Form
    Please use both the HiSNES form and the ABCs form when reporting HiSNES.

Frequently asked questions

• If you have questions regarding these forms, please call 651-201-5414.

Returning the completed form

• After filling out the HiSNES form, please fax it to 1-800-233-1817.

More about HiSNES surveillance

• Haemophilus influenzae (Hi) Neonatal Sepsis Expanded Surveillance (HiNSES)
  Surveillance for Haemophilus influenzae (Hi) Neonatal Sepsis was expanded among neonatal, pregnant and post-partum patients effective January 1, 2016.

Diseases to report with this form

• Reporting Haemophilus influenzae Disease
• Reporting Neonatal sepsis, less than 7 days after birth

More about this disease

• Haemophilus influenzae
• Neonatal Sepsis