Louisiana std report form 2026

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The document is a confidential reporting form (STD 43) from the Louisiana Department of Health for sexually transmitted diseases (STDs), excluding HIV/AIDS. It outlines the necessary patient and provider information, details on various STDs such as chlamydia, gonorrhea, and syphilis, including testing methods and recommended treatments. The form must be completed for each patient diagnosed with an STD and submitted to the health department promptly to ensure proper tracking and management of STDs in the state.

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Click ‘Get Form’ to open the Louisiana STD Report Form in the editor.
Begin by filling out the Provider Information section. Enter your name, facility name, address, and contact details. Ensure all information is accurate for proper reporting.
Next, move to the Patient Information section. Input the patient's medical record number, full name, date of birth, and contact information. Select the appropriate options for sex at birth and gender.
In the Disease section, check all applicable boxes for STDs diagnosed. Be sure to include dates of specimen collection and treatment administered.
Complete any additional fields regarding tests conducted and recommended treatments as specified in the form.
Once all sections are filled out accurately, review your entries for completeness before submitting.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (80 Votes)

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