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Get OR Confidential Sexually Transmitted Disease Case Report - Lane County 2016-2024

Address: City: State: Phone Number: Alternate Phone Number: DOB: Gender: Reason for Exam: Exposed to Infection Race: Sexually Transmitted Disease: Chlamydia Name of Lab: Date Tested: Email Address: F M O Routine Exam Symptomatic Gonorrhea Zip: Pregnant White Pregnant: Yes: Asian Black American Indian/Alaskan Native # of Weeks Ethnicity: Pacific Islander No: Hispanic Other: Unknown Non-Hispanic Presentation: Si.

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