Get Std-23 - Ct.gov - Ct

Filling out the STD-23 Confidential Case Report Form is an important task for reporting sexually transmitted diseases in Connecticut. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently.

Follow the steps to complete the STD-23 form online.

1. Click ‘Get Form’ button to obtain the form in an editable format.
2. Start by entering the patient information. Fill in the name (last and first), middle initial, address (number and street, city or town, state, zip code), date of birth, and sex. Indicate if the patient is pregnant and provide the marital status.
3. Next, provide the race and ethnicity of the patient. Select from the available options, ensuring accurate representation of the individual's background.
4. In the disease information section, check all applicable boxes to indicate the diagnosed sexually transmitted disease. Include details such as whether it is Gonorrhea, Chlamydia, Syphilis, or other STDs.
5. Complete the treatment information section by providing the treatment date, antibiotic details (if applicable), and indicate if the patient was treated. Report any partner notifications that were made.
6. Fill in the diagnostic information, including test date, and specify if results were laboratory confirmed or based on a clinical diagnosis.
7. Next, complete the attending physician information, including their name, address, and phone number. Include the date of the report.
8. Review the entire form for accuracy and completeness, making any necessary edits.
9. Finally, save your changes. You can download, print, or share the form as necessary.

Proceed to complete your document online to ensure timely reporting.