Clinician report of a diagnosed or treated case of syphilis, gonorrhea, chlamydia or chancroid, including treatment and expedited partner therapy, to the NMDOH STD Program.
- Completed by
- Clinician who diagnoses or treats the STD (or clinic staff on the clinician's behalf)
- Issued by
- New Mexico Department of Health, Infectious Disease Bureau, STD Program
- Format
- Fillable PDF
- Language
- English