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Get and Sign California Morbidity Report Form 2018-2022
Neurologic Ocular Otic Late clinical Treated in office Given prescription Drug s Dosage Route Syphilis Test Results RPR Pos Titer Neg VDRL FTA-ABS Neg TP-PA EIA/CLIA CSF-VDRL Treatment Began mm/dd/yyyy If reporting Chlamydia and/or Gonorrhea Specimen Source s Symptoms Cervical Pharyngeal Rectal Urethral Urine Vaginal Untreated Will treat Unable to contact patient Patient refused treatment Referred to Partner s Treated Yes treated in this clinic Yes Meds/Prescription given to patient for their...
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