
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.
- Press the ‘Get Form’ button to obtain the WA DOH 347-102 form and open it in your chosen editor.
- 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.
- Identify the sex assigned at birth and the current gender identity by selecting the appropriate options from the provided checkboxes.
- Indicate whether the patient speaks English. This section is important for understanding the patient's language needs.
- Select the reason for the examination from the options available. Indicate if the patient is pregnant by selecting 'Yes' or 'No' as applicable.
- Complete the section regarding STI testing, including the date tested and checking the appropriate diagnosis for any confirmed infections.
- For each diagnosed STI, specify the sites tested and any presented symptoms by checking the corresponding boxes.
- Filling out race and ethnicity categories is required. Select all applicable checkboxes from the race and ethnicity sections.
- 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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