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Kansas STI/HIV Reporting Form (KDHE)

Kansas Statutes section 65-6002 requires providers and laboratories to report positive test results and treatment for HIV, syphilis, gonorrhea and chlamydia to KDHE, and this two-page form is how providers without electronic reporting do it. A clinician meets it after a positive test or after treating one of these infections. KDHE's STI/HIV Section uses the reports to complete each patient's STI and HIV history and treatment record.

Who completes it

The provider who tests or treats the patient completes the whole form, including the treatment page.

Submitting and payment

How to submit it
Send the completed form by encrypted email to KDHE's STI reporting inbox, by fax (separate lines for STI and for HIV), or by postal mail. Since fall 2025, facilities without electronic lab or case reporting can register for the KORDS portal and enter reports there instead.
Who pays
KDHE lists no fee or payment for STI/HIV reports.

Good to know

  • Treatment is reportable as well as positive results, and KDHE accepts follow-up information through the same email, fax and portal channels.
  • KORDS accepts chlamydia, gonorrhea, HIV, syphilis and congenital syphilis. Each facility applies for an administrative account and registers staff, who enter reports one at a time or by bulk upload.
  • Electronic lab reporting and electronic case reporting from EHRs are also accepted ways to report these infections to KDHE.
  • Pregnant patients with HIV and perinatally exposed infants have their own KDHE forms, including the HIV Perinatal Exposure Report Form.

Get the official form

Download the current version from the source each time; forms change without notice.

Kansas STI/HIV Reporting Form

Official pagePDF

Fill it with Vero

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.

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How this list is checked

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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Frequently asked questions

Which infections are reported on the Kansas STI/HIV Reporting Form?

HIV, syphilis, gonorrhea and chlamydia. K.S.A. 65-6002 requires providers and laboratories to report both positive test results and treatment for these four infections to KDHE. Other notifiable diseases go on the separate Kansas Reportable Disease Form to KDHE epidemiology or the local health department.

Can Kansas STI reports be submitted online?

Yes. Since fall 2025, the Kansas Online Reporting Disease System (KORDS) accepts STI and HIV testing and treatment reports. Each facility must apply for access, and facilities that used KORDS for COVID-19 may need their accounts reinstated. KDHE says the portal reduces follow-up calls and information requests to providers.