Confidential STD Reporting Form

This case report form is essential for both caring for a patient with an infectious disease, and also disease control and prevention. The provider will complete patient information and thoroughly document the records of all STD testing completed at the clinic or laboratory submitting the form. For infectious diseases such as chlamydia, gonorrhea, or syphilis, the provider will check all applicable symptoms of the disease, the date of test, results, and specimen source. The app provides space to document the patient's treatment and a link to essential treatment guidelines for a full explanation of the treatment of STDs. Finally, the health care provider reporting the case will include contact information and facility details.