State Form 56459 is the Indiana Department of Health's confidential case report for sexually transmitted diseases such as chlamydia, gonorrhea and syphilis. A clinician meets it after diagnosing or treating one of these infections. IDOH's Division of HIV/STD/Viral Hepatitis posts it alongside online versions of the same report for each of the three main infections.
The health care provider who diagnoses or treats the STD completes the whole report.
Download the current version from the source each time; forms change without notice.
Indiana Confidential Sexually Transmitted Disease Report
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Yes. The Indiana Department of Health posts online REDCap versions of its confidential STD report, one each for chlamydia, gonorrhea and syphilis, on the HIV/STD/Viral Hepatitis forms page. They are alternatives to the downloadable State Form 56459 for the same infections.
No. IDOH lists separate Confidential HIV/AIDS Case Report Forms for HIV, and a separate viral hepatitis B and C case reporting process. State Form 56459 and its online counterparts are for chlamydia, gonorrhea, syphilis and other sexually transmitted diseases.