ORT Report STIs within 3 work days (WAC 246-101-101/301) PATIENT INFORMATION LAST NAME FIRST NAME MIDDLE NAME DATE OF BIRTH MO ADDRESS ( Unhoused or unstably housed in the past 3 months) TELEPHONE ( EMAIL ) SEX ASSIGNED GENDER IDENTITY AT BIRTH Male Male Female Female Nonbinary / Intersex Genderqueer Refused ENGLISH SPEAKING? Transgender MTF Transgender FTM Other Refused CURRENTLY REASON FOR EXAM (check one): PREGNANT? Exposed to Infection Yes Symptomatic No Routi.

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How to fill out the WA DOH 347-102 - Thurston County online

Filling out the WA DOH 347-102 form online can help ensure timely reporting of sexually transmitted infections (STIs) while maintaining confidentiality. This guide provides a clear, step-by-step approach to completing the form efficiently.

Follow the steps to successfully complete the form.

  1. Press the ‘Get Form’ button to obtain the WA DOH 347-102 form and open it in your chosen editor.
  2. Begin by filling out the patient information section. Enter the patient's last name, first name, middle name, and date of birth in the designated fields.
  3. Identify the sex assigned at birth and the current gender identity by selecting the appropriate options from the provided checkboxes.
  4. Indicate whether the patient speaks English. This section is important for understanding the patient's language needs.
  5. Select the reason for the examination from the options available. Indicate if the patient is pregnant by selecting 'Yes' or 'No' as applicable.
  6. Complete the section regarding STI testing, including the date tested and checking the appropriate diagnosis for any confirmed infections.
  7. For each diagnosed STI, specify the sites tested and any presented symptoms by checking the corresponding boxes.
  8. Filling out race and ethnicity categories is required. Select all applicable checkboxes from the race and ethnicity sections.
  9. After completing all sections of the form, review for accuracy. Once finalized, you can save changes, download, print, or share the form as needed.

Complete your WA DOH 347-102 form online today to ensure accurate and timely reporting.

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