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Get Or Confidential Sexually Transmitted Disease Case Report - Lane County 2013-2024

Ess: City: State: Phone Number: Alternate Phone Number: DOB: Sex: F M O Zip: Email Address: Pregnant: Yes: # of Weeks, No: Marital: S M Reason for Exam: Partner D Unk Symptomatic Routine Exam Exposed to Infection Pregnant Race: White Black Asian Ethnicity: Sexually Transmitted Disease: Chlamydia American Indian/Alaskan Native Pacific Islander Hispanic Other: Unknown Non-Hispanic Gonorrhea Presentation: Diagnosis Date: Asymptomatic.

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