Get Nh Confidential Std Reporting Form 2021-2025

Filling out the New Hampshire Confidential STD Reporting Form online is an essential process for the accurate reporting of sexually transmitted diseases. This guide provides clear instructions to help you complete each section of the form with confidence.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editing tool.
2. Begin by entering the patient information in the designated fields. Fill in the last name, first name, and middle initial, followed by the date of birth in the specified format.
3. Complete the address section, including the city, state, and zip code, along with the employer name. Provide all relevant phone numbers: home, cell, and work.
4. Indicate the birth sex, current gender, and pregnancy status by selecting the appropriate options provided in the form.
5. Specify the primary language spoken by the patient and any drug allergies in the respective fields.
6. Document all sexually transmitted disease tests performed. For each test, indicate whether the patient is asymptomatic or symptomatic, and provide the date of tests along with the reporting lab information.
7. Record the results of the tests (positive or negative) and specify the specimen source for all sites tested.
8. Detail any symptoms noted during the exam, including the onset date of any symptoms and any examination findings.
9. Complete the treatment section, including the date of treatment and the medications prescribed to the patient. Include any specific treatments for pregnant patients if applicable.
10. Provide information regarding the patient's last negative HIV test, whether they are on PrEP, and check any applicable risks associated with the patient.
11. Fill in the healthcare provider and facility information, along with the name and contact number of the person reporting. Finally, indicate the date of reporting.
12. Ensure all sections are completed accurately. Once done, you can save changes, download the form, print it or share it as needed.

Complete the NH Confidential STD Reporting Form online today for accurate reporting and public health safety.