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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the patient information. Fill in the last name, first name, middle name, date of birth, address, telephone number, city, and email. Ensure all fields are completed accurately.
- Indicate if the patient is currently pregnant by selecting 'Yes', 'No', or 'Unknown'.
- Select the reason for the exam from the provided options such as 'Exposed to Infection' or 'Routine Exam'.
- For each STD diagnosis section (Chlamydia, Herpes Simplex, Gonorrhea), check the appropriate boxes based on lab confirmations and symptoms.
- Complete the partner treatment plan section by checking applicable options and providing necessary details about treatment prescribed.
- Finally, fill out the reporting clinic information at the bottom of the form including facility name and contact details before submitting.
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