Mason County Confidential Sexually Transmitted Disease Case Report Form and Fax Prescription for STD Treatment Packs. Washington State Department of Health Confidential Sexually Transmitted Disease Case Report Form and Fax Prescription for 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, middle initial, address, city, state, zip code, date of birth, telephone number, and email.
3. Indicate the patient's sex, ethnicity, race, and gender of sex partners by checking the appropriate boxes.
4. If applicable, specify if the female patient is pregnant and select the reason for the exam from the provided options.
5. Complete the diagnosis section by selecting the disease diagnosed and marking all relevant sites for testing.
6. Fill in treatment details by checking all prescribed medications and entering dates as required.
7. Finally, complete the 'Partner Management Plan' section to outline how partners will be treated and provide clinic information before submitting.

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