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How to fill out the Sexually Transmitted Disease Report Form online
Filling out the Sexually Transmitted Disease Report Form is an important step in reporting and managing sexually transmitted infections. This guide will provide you with detailed instructions to ensure you complete the form accurately and effectively.
Follow the steps to fill out the form online
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Provide patient information by entering the last name, first name, middle initial, and date of birth in the designated fields. Ensure the date is in the format mm/dd/yyyy.
- Indicate the patient's race and ethnicity by selecting the appropriate options. If the race or ethnicity is unknown, make sure to check the respective box.
- Enter the physical address, city, state, and zip code of the patient. Also, provide contact numbers for home, cell, and work as applicable.
- Under disease information, check all applicable diseases for the patient: Chlamydia, Gonorrhea, Syphilis, and HIV. Indicate whether the diagnosis was laboratory confirmed by checking 'Yes' or 'No'.
- If applicable, provide the type of specimen collected and its collection date in the designated fields.
- Fill out treatment information if applicable. Indicate whether treatment was prescribed by selecting 'Yes' or 'No', and provide medication details if treatment was given.
- Specify if Expedited Partner Therapy was provided for the partner(s) and document the number of doses if applicable.
- Complete the reporting section by entering your name, the date reported, and any other requested information.
- Once all information has been entered, save your changes, download a copy, print, or share the completed form as needed.
Take action now and complete your Sexually Transmitted Disease Report Form online.
In most cases, an STD diagnosis will not appear on your permanent medical record unless it is reported as required by law. Health departments track statistics rather than individual cases to protect your privacy. You have the right to manage your health records, ensuring that sensitive information remains confidential. Using a Sexually Transmitted Disease Report Form can help you maintain your personal health data securely.
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