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Phone: 1 (888) 3748824Confidential fax: (801) 5389923Email: reporting@utah.govSyphilis confidential case report form Instruct ions Complete all sections of this form utilizing available data and fax

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How to fill out syphilis confidential case report

01

Obtain the syphilis confidential case report form from the relevant health department or agency.

02

Fill out the form accurately with all the required information, such as patient demographics, medical history, and test results.

03

Include details about the syphilis diagnosis, treatment, and follow-up care.

04

Ensure that all information is complete and legible, and sign the form as required.

05

Submit the completed syphilis confidential case report to the designated authority within the specified timeframe.

Who needs syphilis confidential case report?

01

Healthcare providers who diagnose and treat patients with syphilis.

02

Public health officials who monitor and control the spread of syphilis in the community.

03

Researchers studying syphilis epidemiology and trends.

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What is syphilis confidential case report?

Syphilis confidential case report is a form used to report cases of syphilis to public health authorities while maintaining confidentiality.

Who is required to file syphilis confidential case report?

Healthcare providers, laboratories, and other entities are required to file syphilis confidential case reports.

How to fill out syphilis confidential case report?

The syphilis confidential case report can be filled out electronically or on paper with relevant information about the patient's diagnosis and treatment.

What is the purpose of syphilis confidential case report?

The purpose of the syphilis confidential case report is to monitor and track cases of syphilis for public health surveillance and intervention.

What information must be reported on syphilis confidential case report?

The syphilis confidential case report must include information such as patient demographics, test results, treatment information, and provider contact information.

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