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Partner Notification Form Treatment Site: Treatment Date: Index Client Name: Gender: D.O.B: CH No: M × F Number of Partners in last 6 months: Please obtain details of all partners within the last

How to fill out partner notification form

How to fill out partner notification form:

1. Obtain the partner notification form from a healthcare provider or a local health department. It is typically available in clinics or can be downloaded from the internet.
2. Fill in your personal information, such as your name, date of birth, and contact details, accurately and completely in the designated fields on the form.
3. Provide the necessary information about the person you are notifying. This might include their name, contact details, and any relevant medical information that you are aware of or have been provided by a healthcare professional.
4. Specify the method of notification you prefer, such as a phone call, email, or in-person meeting, and indicate your availability for contact.
5. If applicable, include any additional information or concerns that you would like to share with the person being notified. This could include details about any potential exposure risks or relevant medical information.
6. Review the completed form to ensure all the required fields are filled out accurately and any necessary attachments or supporting documents are included.
7. Sign and date the form to confirm that the information provided is true and accurate to the best of your knowledge.

Who needs partner notification form:

1. Individuals who have been diagnosed with a sexually transmitted infection or disease (STI/STD) may need a partner notification form.
2. Any person who has had sexual contact with someone diagnosed with an STI/STD should also consider filling out a partner notification form.
3. Healthcare providers or local health departments often require individuals diagnosed with certain STIs/STDs to complete a partner notification form as part of the disease control and prevention efforts.

Note: It is always recommended to consult with a healthcare professional or local health department for specific instructions and guidance on filling out a partner notification form.

For pdfFiller’s FAQs

What is partner notification form?

The partner notification form is a document used to inform individuals about their potential exposure to a sexually transmitted infection.

Who is required to file partner notification form?

Individuals who have tested positive for a sexually transmitted infection are required to file a partner notification form.

How to fill out partner notification form?

The partner notification form can be filled out by providing information about the individual's sexual partners and potential exposure.

What is the purpose of partner notification form?

The purpose of the partner notification form is to help prevent the spread of sexually transmitted infections by informing individuals about their potential exposure.

What information must be reported on partner notification form?

Information on sexual partners and potential exposure to sexually transmitted infections must be reported on the partner notification form.

How can I send partner notification form for eSignature?

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