Get Confidential Std Case Report Form (pdf: Kb/2 Pages) - Health Mn

This guide aims to assist users in successfully completing the Confidential STD Case Report Form required by Health Mn. Understanding how to fill out this form correctly is essential for ensuring the report is processed efficiently.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient’s last name, first name, and middle initial in the designated fields. Ensure all information is typed clearly and legibly.
3. Provide the patient’s country of birth, date of birth (in MM-DD-YYYY format), and demographic details such as ethics and race from the listed options. Mark all applicable boxes.
4. Include the patient’s contact information, including a current address and phone number. If the address is unknown or if the patient is homeless, select the appropriate options provided.
5. Indicate the patient’s gender and pregnancy status by marking one option in each section. Ensure to record any relevant notes regarding expected due dates if applicable.
6. Document laboratory confirmations for chlamydia and gonorrhea, including the specimen collection dates and diagnosis by marking the appropriate fields.
7. Complete the treatment section by indicating whether treatment was administered, and if so, specify the medication used along with the treatment dates.
8. Provide information on any untreated partners if applicable, as it is essential for partner notification and public health purposes.
9. Fill out the provider information section with the name, telephone number, and clinic details for the healthcare provider submitting the report.
10. Once all sections are completed, review the information for accuracy before saving changes, downloading, printing, or sharing the form.

Complete the Confidential STD Case Report Form online today to ensure accurate and timely reporting.