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. Fill in 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 options that apply to the patient.
5. For reporting diseases, check off any applicable conditions under Chlamydia and Gonorrhea. Include collection dates and reporting laboratory information as required.
6. Complete treatment details by selecting from CDC recommended regimens based on the patient's condition and pregnancy status if applicable.
7. Finally, review all entries for accuracy before submitting your report through our platform.

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