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WA DOH 347-102 - Cowlitz County 2016 free printable template

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FAX page 1 to Adapted from Washington State Department of Health Form DOH 347-102 Cowlitz County Health Department s confidential fax line 360 425-7531 CONFIDENTIAL SEXUALLY TRANSMITTED DISEASE STD CASE REPORT Report STDs within three working days. WAC 246-101-101/301 PATIENT INFORMATION Last Name First Name Middle Initial Address City Email Address Telephone Date of Diagnosis Month Ethnicity Hispanic Non-Hispanic Unknown Day Year Sex Male Female Race check all that apply White Black American...
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Obtain a copy of the WA DOH 347-102 form from the Cowlitz County Health Department website or office.
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Read the instructions carefully to understand the information required.
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Fill in the applicant's full name and contact information in the designated fields.
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Provide details about the property or business associated with the application, including address and owner information.
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Complete any additional sections, such as health and safety information, as required.
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Review all entered information for accuracy and completeness.
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Submit the form either in person at the Cowlitz County Health Department, by mail, or as directed in the instructions.

Who needs WA DOH 347-102 - Cowlitz County?

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Individuals or businesses seeking permits related to health and safety regulations in Cowlitz County.
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Property owners who need to report health concerns or violations.
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Organizations or contractors involved in public health projects or renovations.
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WA DOH 347-102 is a form used for reporting certain health-related information in Cowlitz County, Washington, as required by the Department of Health.
Entities such as healthcare providers, laboratories, and other relevant organizations that are involved in the reporting of specific health data in Cowlitz County are required to file this form.
The form should be filled out by providing accurate details as required in the sections specified, ensuring all mandatory fields are completed, and submitting it to the appropriate health department authority.
The purpose of WA DOH 347-102 is to gather important health data for monitoring public health trends, disease outbreaks, and ensuring compliance with health regulations in Cowlitz County.
Information that must be reported includes patient demographics, diagnosis codes, treatment information, and any other relevant health data related to the conditions being monitored.
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