2012 WA DOH 347-102 - Benton-Frankliny-2026

1. Click ‘Get Form’ to open the 2012 WA DOH 347-102 - Benton-Frankliny in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, middle initial, address, telephone number, city, state, and ZIP code.
3. Provide the date of diagnosis and select the ethnicity and race options that apply. Ensure you check the appropriate reason for examination.
4. In the 'Diagnosis – Disease' section, indicate if Gonorrhea or Chlamydia is lab confirmed by checking the relevant box. Fill in any symptoms and treatment prescribed.
5. Complete the 'Partner Management Plan' by selecting a method for ensuring partner treatment. Indicate how many partners will be treated.
6. Finally, fill out the 'Reporting Clinic Information' with details about the diagnosing clinician and facility. Ensure all information is accurate before submission.

Start using our platform today to easily complete your forms online for free!