Follow the steps to successfully fill out the form.

1. Press the ‘Get Form’ button to access the form and enable its editing features.
2. Begin by entering the patient's information. Include the last name, first name, and middle name in the designated fields. Ensure that all entries are accurate.
3. Provide the date of birth in the specified format. Follow this by entering the full address, including the city, state, zip code, and telephone number.
4. Indicate whether the patient is currently pregnant by checking the appropriate option, and confirm if they are an English speaker.
5. Select the reason for the exam from the available checkboxes, marking 'Exposed to Infection,' 'Symptomatic,' or 'Routine Exam.'
6. Fill out relevant fields for sexually transmitted diseases, including typing the date tested for specific STDs such as chlamydia and gonorrhea, and recording diagnosis details as applicable.
7. Document any treatments provided, specifying medication dosages and dates prescribed in the appropriate sections.
8. Complete the partner treatment plan, noting any partners treated and the methods employed for treatment.
9. Provide reporting clinic information, including the facility name, address, the person completing the form, diagnosing clinician, and contact information.
10. Once all the required fields are filled, review for accuracy and completeness. Save changes, then download, print, or share the completed form as needed.

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