Std form pdf 2025

1. Click ‘Get Form’ to open the STD/HIV Report Form in the editor.
2. Begin by filling out the Patient Information section. Enter the patient's last name, first name, middle initial, and date of birth in the specified format (mm/dd/yyyy).
3. Select the patient's race and ethnicity from the provided options. If applicable, indicate if the patient is pregnant and specify the number of weeks.
4. Complete the Physical Address fields, including street address, city, state, and zip code. Provide contact numbers for home, cell, and work if available.
5. In the Disease Information section, check all relevant diseases such as Chlamydia or Gonorrhea. Indicate whether diagnoses were laboratory confirmed and specify specimen types.
6. Fill out Treatment Information if applicable. Indicate whether treatment was prescribed and list medications along with dosages and duration.
7. Finally, complete the Reported by section with your name and date reported before submitting.

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