T from disclosure and is intended solely for the use of the individual(s) named above. If you are not the intended recipient, you are hereby advised that any dissemination, distribution or copying of this communication is prohibited. If you have received this facsimile in error, please immediately notify the sender by telephone and destroy the original facsimile. (8/2016) Page 1 Reviewed 8/2016 PARTNER MANAGEMENT PLAN INSTRUCTIONS PARTNER TREATMENT Chlamydia & Gonorrhea Providers are to manag.
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How to fill out the WA DOH 347-102 - Cowlitz County online
Filling out the WA DOH 347-102 - Cowlitz County form online is a straightforward process that helps ensure accurate reporting of sexually transmitted diseases. This guide will provide step-by-step instructions to help users complete the form effectively while maintaining confidentiality.
Follow the steps to fill out the form correctly.
- Click ‘Get Form’ button to access the form and open it in your preferred editor.
- Begin by entering the patient information: Last name, first name, middle initial, address, city, email address, and telephone number.
- Provide the date of diagnosis by filling in the month, day, and year. Select the patient's ethnicity by checking the appropriate box: Hispanic, Non-Hispanic, or Unknown.
- Indicate the patient's gender by checking 'Male', 'Female', or 'Other'. Fill in the race by checking all that apply and fill in the state and zip code.
- If the patient is female, indicate if they are pregnant by checking 'Yes', 'No', or 'Unknown'.
- Specify the gender of sex partners by checking the relevant option: Male, Both, Female, or Unknown.
- Provide the patient's date of birth.
- Select the reason for the exam by checking one of the options: Symptomatic, Routine exam – no symptoms, or Exposed to infection.
- Indicate if the patient was tested for HIV at this visit by checking 'Yes', 'No', or 'Previous positive'.
- Report the diagnosis information for gonorrhea and chlamydia, selecting the respective options and providing details on treatment prescribed, if applicable.
- Complete the partner management plan by selecting the method of ensuring partner treatment.
- Fill in reporting clinic information including the date, diagnosing clinician, facility name, person completing the form, and their contact information.
- Once all necessary fields have been completed, users can save changes, download, print, or share the completed form.
Complete the WA DOH 347-102 - Cowlitz County form online to ensure accurate reporting and maintain confidentiality.
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Dec 14, 2022 — DOH 347-102, updated 12/14/2022. For persons with disabiliƟes, this...
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