Indiana Confidential Sexually Transmitted Disease Report

Form Template

To prevent the spread of communicable diseases, a health department takes precautions in interviewing patients with an STD and gathering information about the illness, treatment, and others at risk of contracting the infection.

5,000 Companies save time and money with GoCanvas

Lumen Logo Post Consumer Brands Logo Saluda Hill Landscapes Logo Te3co Logo Two Men and a Truck Logo VIP Lighting Logo

Collecting this information is vital to disease control and prevention. The Indiana Confidential Sexually Transmitted Disease Report app is used by health investigators to report positive cases of chlamydia, gonorrhea, and syphilis. After giving basic patient information, the health investigator will indicate the specific STD the patient tested positive. If it was a pelvic inflammatory disease, such as chlamydia, gonorrhea, the interviewer will complete one set of questions. For syphilis, the interviewer will complete a separate section. In each section, the interviewer will note the specimen source, indicate others at risk of the infection, and describe the treatment regimen and treatment date.

Features
  • Signature Capture
  • GPS
  • Image Capture
  • Conditional Fields
Read More
Platforms
  • iPhone
  • iPad
  • Android
  • Windows
Read More
Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
Read More
*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

Connect with one of our experts today.

We’ll help you put together the right solution for your needs.

Contact Us