Rt STDs within three work days (WAC 246-101-101/301) PATIENT INFORMATION LAST NAME FIRST NAME ADDRESS CITY DATE OF BIRTH MO SEX YR ( ETHNICITY Male Female Transgendered Male to Female Transgendered Female to Male If Female, PREGNANT? ) RACE (Check all that apply) DAY Male Female Both Unknown HIV TESTED AT THIS VISIT?* Symptomatic Routine Exam – No Symptoms Exposed to Infection Unknown GENDER OF SEX PARTNERS White Asian Black Other Unknown American Indian/Alaskan Native Native Ha.
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How to fill out the WA DOH 347-102 - Thurston County online
Filling out the WA DOH 347-102 - Thurston County form is a crucial step in reporting sexually transmitted diseases. This guide will walk you through the online process, ensuring you accurately complete each section with confidence.
Follow the steps to complete the form effectively.
- Press the ‘Get Form’ button to access the WA DOH 347-102 form and open it in your preferred online editor.
- Begin by entering the patient information. Fill out the last name, first name, middle initial, address, city, state, and ZIP code. Make sure to input the date of birth in the specified format (MO/DAY/YR). Select the gender and indicate pregnancy status if applicable.
- For the ethnicity and race sections, check all that apply. This information is vital for accurate reporting.
- Indicate whether the patient was tested for HIV at this visit and provide details regarding symptoms or exposure.
- In the diagnosis section, check the appropriate box for the disease diagnosed and include all applicable sites of infection.
- Next, document the treatment prescribed. Select all medications given, indicating any alternatives if necessary.
- Complete the partner management plan by selecting the method used for ensuring partner treatment. Provide the number of partners treated as applicable.
- Fill in the reporting clinic information, including the date, facility name, address, diagnosing clinician's name, and the person completing the form.
- Review all entered information for accuracy and completeness before proceeding. Once finalized, you can save changes, download the document, print it, or share it as needed.
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