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Click ‘Get Form’ to open the California Syphilis Reporting Form in our editor.
Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, date of birth, and medical record number. Ensure all fields are completed accurately.
Next, provide details regarding the patient's gender, ethnicity, race, and primary language spoken. Use checkboxes for options like 'Male', 'Female', or 'Transgender'.
In the 'Clinical Information' section, indicate if the patient is pregnant and provide the diagnosis date. Specify any symptoms and the stage of syphilis diagnosed.
Complete the treatment information by entering the treatment date and specifying the type of treatment administered.
Fill in the 'Testing Agency Information' with provider details including name, facility, phone number, and address.
Finally, complete any administrative information required at the end of the form before saving your work.

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Is syphilis reportable to the CDC?

Syphilis (including congenital syphilis), gonorrhea, chlamydia, chancroid, and are reportable diseases in every state. Reporting and Confidentiality - CDC CDC std clinical-reporting CDC std clinical-reporting

What STDs do you legally have to disclose in California?

In Ohio, healthcare providers and facilities are required per Ohio Administrative Code 3701-3-02 to report the occurrence of cases or suspected cases of Chancroid, Chlamydia, Gonorrhea and Syphilis infection under their care and treatment to the public health authority.

Does syphilis have to be reported?

Which STDs Must Be Reported to the Health Department? Gonorrhea. Syphilis (infections, latent (early late), late stages congenital) Chlamydia. Chancroid. AIDS. . Viral Hepatitis (A,B and C) Amebiasis. Sexually Transmitted Diseases Control - dhs.saccounty.gov dhs.saccounty.gov - Sacramento County PUB Pages GI-STD-Control dhs.saccounty.gov - Sacramento County PUB Pages GI-STD-Control

What STDs have to be reported to the health Department in California?

The Disease Control and Epidemiology unit monitors the rates of reportable sexually transmitted diseases (STDs). These include gonorrhea, chlamydia and syphilis.

Which STDs are reportable in California?

Overview. Surveillance information on the burden of STDs is used to inform public and private health efforts to control these diseases. Case data are available for nationally notifiable STDs, including chancroid, chlamydia, gonorrhea, and syphilis. Sexually Transmitted Disease (STD) Surveillance - Health, United States CDC nchs hus sources-definitions CDC nchs hus sources-definitions