Note: All patient information is confidential. Only the patient's initials and date of birth are required as identifying markers to avoid duplication of reporting.
Data collected from health care providers' pesticide injury reports will be compiled in a yearly report assessing reported pesticide injury in the state to the MPN. The annual report will be shared with appropriate state agencies, the Governor, state health care professional associations and health care providers that have submitted a suspected pesticide injury report during the report year. Annual reports will not include identifying markers of individual patients.
Complete the online
form.