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1. Provider will ensure all partners treated medications available. Number to be treated Turn over for Partner Plan Instructions 2. All partners have been treated* Number treated all other STD cases will NOT be investigated Herpes Simplex Chancroid Granuloma Inguinale Lymphogranuloma Venereum. REPORTING CLINIC INFORMATION Date Diagnosing Clinician Facility Name Person Completing Form Email Thank you for reporting a STD. All information will be managed with the strictest confidentiality. PRIVILE ...

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