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FL Confidential Report of Sexually Transmitted Diseases - Indian River County 2019-2025 free printable template

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***PLEASE ENCLOSE LAB***FLORIDA CONFIDENTIAL REPORT OF SEXUALLY TRANSMITTED DISEASESFloridaHEALTHPROVIDER INFORMATION TO REPORT HIV/AIDS Contact: PAT SEINER PHONE: 7724623875 or FAX: 7724625096DATE
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How to fill out FL Confidential Report of Sexually Transmitted Diseases

01
Obtain the FL Confidential Report of Sexually Transmitted Diseases form from your local health department or their website.
02
Fill out the patient’s information in the designated fields, including their name, address, and date of birth.
03
Provide details about the STI diagnosis, including the type of infection and date of diagnosis.
04
Include any relevant clinical information, such as symptoms and treatment received.
05
Indicate if the patient has any partners who may have been exposed and provide their information if known.
06
Check the box for confidentiality and ensure the form is submitted securely.
07
Review the completed form for accuracy and sign it if required.
08
Submit the form to the appropriate health department or agency following the instructions provided.

Who needs FL Confidential Report of Sexually Transmitted Diseases?

01
Healthcare providers diagnosing STDs in Florida are required to complete this report.
02
Clinics and hospitals that provide testing and treatment for sexually transmitted diseases.
03
Public health officials monitoring and preventing the spread of sexually transmitted diseases in the community.
04
Researchers studying patterns and trends in STDs in Florida.
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The FL Confidential Report of Sexually Transmitted Diseases is a form used in Florida to report cases of sexually transmitted infections (STIs) to the health department, ensuring public health tracking and intervention.
Healthcare providers, including doctors, clinics, and hospitals, are required to file the FL Confidential Report of Sexually Transmitted Diseases for patients diagnosed with STIs.
To fill out the FL Confidential Report of Sexually Transmitted Diseases, healthcare providers must complete all sections of the form, including patient demographics, STI diagnosis, treatment information and submit it to the local health department.
The purpose of the FL Confidential Report of Sexually Transmitted Diseases is to monitor and control the spread of STIs, facilitate public health responses, and provide data for research and treatment programs.
The information that must be reported includes the patient's name, date of birth, sex, address, the type of STI diagnosed, date of diagnosis, treatment given, and other epidemiological information as required.
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