OSDH Form 235 "Monthly Laboratory Report of Tests Performed for Sexually Transmitted Diseases" - Oklahoma

What Is OSDH Form 235?

This is a legal form that was released by the Oklahoma State Department of Health - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2011;
  • The latest edition provided by the Oklahoma State Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of OSDH Form 235 by clicking the link below or browse more documents and templates provided by the Oklahoma State Department of Health.

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Download OSDH Form 235 "Monthly Laboratory Report of Tests Performed for Sexually Transmitted Diseases" - Oklahoma

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Oklahoma State Department of Health
Monthly Laboratory Report of Tests Performed for Sexually Transmitted Diseases
FOR LABORATORIES ONLY
(Please type or print clearly)
_________________________________
_______________________________
Name of Lab
Month of Report
____________________________________
Address
_____________
Date Mailed
________________________________
City, State Zip
Check if need Supply of:
(_______) ______________________
Phone Number
 Forms
 Envelopes
___________________________
Form Completed by
Type of Test Performed
Date of
(Report only positive results.)
Specimen
Patient Name
County of
DOB
Race
Sex
Physician Name
Syphilis*
CT
GC
HIV*
Collection
(Last Name, First Name)
Residence
& Phone Number
th
Please mail all positive test results to OSDH HIV/STD Service Surveillance Office 1000 NE 10
Maildrop 0308 Oklahoma City, OK 73117.
ODH Form 235
*NOTE: Please report all positive HIV results (mail only) and all positive Syphilis results (mail or fax) within 24 hrs of test results.
Revised Sept 2011
For questions or additional information, contact the OSDH HIV/STD Service by phone at (405) 271-4636 or fax (405) 271-1187.
Oklahoma State Department of Health
Monthly Laboratory Report of Tests Performed for Sexually Transmitted Diseases
FOR LABORATORIES ONLY
(Please type or print clearly)
_________________________________
_______________________________
Name of Lab
Month of Report
____________________________________
Address
_____________
Date Mailed
________________________________
City, State Zip
Check if need Supply of:
(_______) ______________________
Phone Number
 Forms
 Envelopes
___________________________
Form Completed by
Type of Test Performed
Date of
(Report only positive results.)
Specimen
Patient Name
County of
DOB
Race
Sex
Physician Name
Syphilis*
CT
GC
HIV*
Collection
(Last Name, First Name)
Residence
& Phone Number
th
Please mail all positive test results to OSDH HIV/STD Service Surveillance Office 1000 NE 10
Maildrop 0308 Oklahoma City, OK 73117.
ODH Form 235
*NOTE: Please report all positive HIV results (mail only) and all positive Syphilis results (mail or fax) within 24 hrs of test results.
Revised Sept 2011
For questions or additional information, contact the OSDH HIV/STD Service by phone at (405) 271-4636 or fax (405) 271-1187.
This form should be completed and mailed at the end of each month in the gray, confidential postage-paid pre-addressed envelopes provided. If
there are no positive labs to report, there is not a need to mail the report to the central office. All mail should be labeled ‘Confidential’. Form
can also be downloaded from the Oklahoma State Department of Health website at
http://www.ok.gov/health/Disease,_Prevention,_Preparedness/HIV_STD_Service/HIV_STD_Reporting_Forms
Please mail all positive HIV and mail or fax all positive Syphilis results within 24 hours of test result.
Oklahoma State Department of Health
HIV/STD Service
Surveillance and Analysis Office
Mail Drop 0308
th
1000 NE 10
St.
Oklahoma City, OK 73117
Fax: (405) 271-1187
Phone: (405) 271- 4636
The following laboratory tests for sexually transmitted diseases are reportable to the State Department of Health as provided in Public Health Code
(OAC § 310:515-1-3, OAC § 310:515-1-4), and other governing regulations:
1. All reactive serologic and spinal fluid tests for syphilis
2. All positive darkfield microscopic tests (for syphilis)
3. All positive tests indicating presence of Neisseria gonorrhoeae
4. All positive tests indicating presence of Chlamydia trachomatis
5. All positive tests indicating presence of HIV infection
ALL STD REPORTS ARE CONFIDENTIAL AND NO PATIENT IS CONTACTED
WITHOUT THE NOTIFICATION OF THE ATTENDING PHYSICIAN.
**PHIDDO (Public Health Investigation and Disease Detection of Oklahoma)
The preferred method of reporting diseases or conditions to the OSDH is through the secure, web-based PHIDDO system. PHIDDO is a user-
friendly, internet-based application which is only accessible to persons with specific authorization to enter and view records and information.
Online case reporting eliminates the need for faxing and mailing reports to OSDH.
If you are a Physician, Physician Assistant, Nurse Practitioner, Infection Preventionist, Laboratorian, or any other clinical or healthcare
professional who would be submitting cases of reportable diseases PHIDDO will be a good reporting option. To register or if you have any
questions about PHIDDO, please contact Tony McCord or Anthony Lee at (405) 271-4060.
ODH Form 235
Revised Sept 2011
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