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The STD-23 and other reportable disease forms are available on our website www. ct. gov/dph/forms. Health Insurance Portability and Accountability Act HIPAA Guidelines Pursuant to Connecticut General Statutes CGS 19a-2a and 19a-215 and to the Regulations of Connecticut State Agencies s 19a-36-A3-4 the requested information is required to be provided to the DPH. Sexually Transmitted Disease Confidential Case Report Form STD-23 rev. 5/13/2016 State of Connecticut Department of Public Health...
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Confidential case report form is a document used to report confidential information about a case or incident.
Certain individuals or organizations may be required to file confidential case report form as per regulations or policies.
Confidential case report form should be filled out with accurate and detailed information about the case or incident.
The purpose of confidential case report form is to gather and document important information about a case for further analysis or investigation.
Confidential case report form may require information such as date, time, location, individuals involved, and a detailed description of the incident.
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