Get Confidential Sexually Transmitted Disease (std) Case Report - Health ...

Filling out the Confidential Sexually Transmitted Disease (std) Case Report is an essential process for reporting STDs accurately and confidentially. This guide provides clear instructions on how to complete the form online, ensuring that all necessary information is submitted correctly.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient information. Fill in the last name, first name, and middle initial. Ensure that you provide an accurate address, city, and zip code, followed by the email address and telephone number.
3. Document the date of diagnosis by filling in the month, day, and year. Select the ethnicity of the individual, choosing from the options provided: Hispanic, Non-Hispanic, or Unknown.
4. Specify the gender of the person being reported. Indicate if the individual is pregnant, if applicable, and complete the section regarding the gender of their sex partners.
5. Enter the date of birth of the individual and select the reason for their exam from the provided options. Document whether an HIV test was conducted during this visit.
6. In the Diagnosis section, indicate the specific STD diagnosis. Provide details regarding symptomatology, as well as the sites where testing was conducted.
7. List the treatment prescribed for the diagnosed STDs, along with the dates that treatment was prescribed.
8. Complete the Partner Management Plan, indicating the method of ensuring partner treatment and the number of partners treated.
9. Fill out the Reporting Clinic Information section with the date, diagnosing clinician's name, facility name, and the person completing the form.
10. Review all entered information for accuracy, then save changes, download, print, or share the form as needed.

Take the important step of filling out the Confidential Sexually Transmitted Disease (std) Case Report online today.