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Utah Department of Health
288 North 1460 West
P.O. Box 142104
Phone: (801) 5386191Confidential Fax (801) 5389923CONFIDENTIAL CASE
REPORTChlamydia and Gonorrhea
INSTRUCTIONSPlease complete all sections
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What is box 142104?
Box 142104 is a section on a specific form used for reporting certain financial information.
Who is required to file box 142104?
Individuals or entities who meet specific criteria outlined by the governing body
How to fill out box 142104?
Box 142104 must be filled out accurately and completely following the instructions provided by the governing body.
What is the purpose of box 142104?
The purpose of box 142104 is to collect specific financial information for regulatory or compliance purposes.
What information must be reported on box 142104?
Box 142104 typically requires reporting of income, expenses, or other financial data.
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