Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access the WA DOH 347-102 - Jefferson County form and open it for editing.
2. Begin by providing patient information. Fill out the last name, first name, middle initial, and date of birth. Specify the patient's address, city, state, zip code, and include an email and telephone number.
3. Indicate the patient's ethnicity and race by checking the appropriate boxes provided on the form. Ensure that you accurately capture the required information concerning the patient's identity.
4. Report on the patient's gender and their sexual partners' gender. Check all that apply to ensure a complete picture of potential exposure.
5. Provide the date of diagnosis, the reason for the exam, and if applicable, specify if the patient is pregnant.
6. In the diagnosis section, select the disease from the options provided by checking only one box according to the laboratory confirmation.
7. List the treatment prescribed, ensuring you specify the date prescribed and check all applicable treatments for the diagnosed conditions.
8. Complete the partner management plan section by choosing the method of ensuring partner treatment and providing the required details.
9. Fill in the reporting clinic information, including the date, facility name, address, diagnosing clinician's name, and contact information for the person completing the form.
10. Review all entered information for accuracy and completeness before saving your changes, downloading, printing, or sharing the completed form as needed.

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