
Fax Page 1 To:Adapted from WA DOH Form 347102Kitsap County Health District(360) 8131168 (Confidential FAX line)CONFIDENTIAL SEXUALLY TRANSMITTED DISEASE CASE REPORT Report STDs within three work days.
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How to fill out the WA DOH 347-102 - Kitsap County online
Filling out the WA DOH 347-102 form online is a straightforward process that helps users report sexually transmitted infections in Kitsap County. This guide provides clear, step-by-step instructions to help ensure that all necessary information is accurately submitted.
Follow the steps to effectively complete the form online:
- Click the ‘Get Form’ button to access the online version of the WA DOH 347-102 form and open it in your preferred online editor.
- Begin by entering patient information in the designated fields. Input the last name, first name, and middle name as prompted. Do not forget to provide the date of birth and contact details, including telephone number and email address.
- Indicate the patient's housing situation by selecting the option that applies (Unhoused or unstably housed in the past 3 months).
- Fill out gender identity and preferred pronouns. Choose the appropriate options provided, which may include Transgender MTF, Transgender FTM, or others as applicable.
- Complete the section regarding pregnancy status. Indicate whether the patient is pregnant by selecting 'Yes' or 'No'.
- Provide detailed information regarding the diagnosis date. Enter the month, day, and year when the diagnosis was made.
- Select the race categories and ethnicity by checking all applicable boxes. Make sure to encompass all relevant options to best represent the patient's demographics.
- Complete the diagnosis field by checking the applicable STI diagnosis, along with the sites tested. Ensure that all sites that apply are accurately checked.
- After completing all sections thoroughly, review the form to verify that all information is correct and complete.
- Save your changes to the form. You may also choose to download, print, or share the completed form as necessary.
Complete your forms swiftly and accurately online to ensure effective reporting and management of health information.
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