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Laboratory Name SEXUALLY TRANSMITTED DISEASES STDs Gender of Sex Partners check all that apply STD TREATMENT If reporting Syphilis Stage Primary lesion present Secondary Early latent 1 year Latent unknown duration Late latent 1 year Late tertiary Congenital Neurosyphilis Treated in office Given prescription Drug s Dosage Route RPR Pos Titer Neg VDRL FTA-ABS Neg TP-PA EIA/CLIA CSF-VDRL Syphilis Test Results Treatment Began mm/dd/yyyy Untreated Will treat Unable to contact patient Patient...
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