Colorado providers use this 1-page form to report syphilis cases to CDPHE's STI/HIV/Viral Hepatitis Branch. It records the patient, partners in the last 3, 6 and 12 months, a facility contact, HIV and pregnancy testing, nontreponemal and treponemal results with titers, stage, neurologic, ocular or otic involvement, and treatment dates. It can only be sent by email or fax.
The diagnosing or treating provider or facility completes the whole form and names a facility contact person for STD reporting.
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Confidential Syphilis Case Reporting Form
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No. CDPHE says the confidential syphilis case reporting form can only be sent by email or fax. STI treatment information, however, should be reported through the Reportal, and STI labs preferably through electronic laboratory reporting.
It asks for the performing lab, specimen dates and accession ID, nontreponemal tests (RPR or VDRL) with titer, treponemal tests (TP-PA, FTA-ABS or EIA/CIA), CSF-VDRL with titer, rapid tests and darkfield results.