STD Reporting Form 06-2012 - Lane County Government - lanecounty-2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal information, including First Name, Middle Name, Last Name, Address, City, State, Zip Code, Phone Number, and Email Address. Ensure all details are accurate for effective communication.
3. Indicate your Date of Birth (DOB) and Sex. If applicable, specify if you are pregnant and provide the number of weeks.
4. Select your Marital status and Reason for Exam from the provided options. This helps in understanding the context of your visit.
5. Fill out the Race and Ethnicity sections accurately. This data is crucial for public health statistics.
6. Document any sexually transmitted diseases (STDs) you have been diagnosed with and include relevant treatment information.
7. Complete the Sexual Partner Information section thoroughly to ensure proper follow-up and treatment recommendations.
8. Review all entries for accuracy before submitting. Use our platform’s features to save or print a copy for your records.

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