Washington requires providers to report sexually transmitted infections to the local health jurisdiction within 3 work days under WAC 246-101-101 and 246-101-301. The Confidential Sexually Transmitted Infection Case Report, adapted from DOH Form 347-102, records the patient, diagnosis date, disease, sites, stage, lab confirmation and treatment prescribed. Page 2 adds a partner management plan.
The diagnosing clinician or reporting clinic completes the whole form, including the patient's HIV status, PrEP use and pregnancy, and the person completing the form. There is no patient section.
Download the current version from the source each time; forms change without notice.
Confidential Sexually Transmitted Infection Case Report
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Use the version for the patient's county of residence. DOH lists case report PDFs by county, each adapted from Form 347-102 with a fax page for that county. King, Tacoma-Pierce, Spokane and Snohomish counties link to their own websites for their forms.
Three work days, under WAC 246-101-101 and 246-101-301, as printed at the top of the form. The report goes to the local health jurisdiction rather than the state. Congenital syphilis is reported on the separate DOH 150-289 case report.