FLORIDA CONFIDENTIAL REPORT OF SEXUALLY TRANSMITTED DISEASES CHLAMYDIA, GONORRHEA, OTHER 2025

1. Click ‘Get Form’ to open the FLORIDA CONFIDENTIAL REPORT in the editor.
2. Begin by entering the patient's personal information, including their name, date of birth (DOB), Social Security Number (SSN), address, phone number, and email. Ensure all details are printed legibly or use a label for clarity.
3. Indicate the patient's gender and pregnancy status by selecting the appropriate options. If pregnant, provide the estimated due date (EDD).
4. In the race and ethnicity sections, select the relevant categories that apply to the patient.
5. Fill in provider information including name and contact details. This is crucial for follow-up communication.
6. For reporting diseases like Chlamydia and Gonorrhea, check all applicable boxes and provide collection dates along with laboratory information.
7. Complete treatment details as per CDC recommendations. Make sure to document treatment dates accurately.

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