Get Wa Doh 347-102 - Benton-frankliny 2012

The WA DOH 347-102 is a critical document used to report sexually transmitted diseases (STDs) in Benton-Franklin County. Completing this form accurately and promptly is essential for public health safety and individual patient care. This guide provides step-by-step instructions to assist you in filling out the form online with confidence and efficiency.

Follow the steps to complete the WA DOH 347-102 form online.

1. Press the ‘Get Form’ button to access the WA DOH 347-102 form, ensuring you have it open in your editing interface.
2. Begin by entering the patient information in the designated fields. This includes the last name, first name, middle initial, address, telephone number, city, state, zip code, date of diagnosis, ethnicity, race, and date of birth. Make sure to fill in all mandatory fields.
3. Indicate the reason for the exam by selecting one of the following options: symptomatic, routine exam with no symptoms, or exposed to infection.
4. Select the patient's gender from the options provided: male, female, both, or unknown, ensuring accurate representation of the patient’s identity.
5. Under the diagnosis section, specify the disease diagnosed, such as gonorrhea, chlamydia, syphilis, or herpes simplex. For each diagnosis, complete the corresponding sections for symptom status, date tested, treatment prescribed, and any additional complications.
6. For the partner management plan, choose the method to ensure partner treatment, such as whether the provider will ensure all partners are treated, if all partners have already been treated, or if the health department will assume responsibility for partner treatment.
7. Complete the reporting clinic information section, including the date, diagnosing clinician, facility name, person completing the form, and their contact information. Ensure this information is accurate for tracking and follow-up.
8. Once all fields are completed, review the form for accuracy and completeness. Save your changes, and you will have the options to download or print the form for submission. Ensure the form is sent to the Benton-Franklin Health District via their confidential fax line.

Start filling out the WA DOH 347-102 form online today to ensure timely reporting and support for public health!