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8 lip 2024 · The Sexually Transmitted Disease (STD) Program strives to prevent and reduce the effects of STDs in New Jersey through partner services, education, technical assistance, surveillance, and partnerships with local health and community organizations. STD Program Number: 609-826-4869
- Health Department Forms
Forms for HIV, STD and TB Services AIDS Drug Distribution...
- Health Department Forms
Forms for HIV, STD and TB Services AIDS Drug Distribution Program (ADDP)
Before completing and submitting the form, please read the following directions carefully. Failure to follow these directions could result in the delay or rejection of the specimen.
The State of New Jersey Department of Health Sexually Transmitted Disease Program STD CASE REPORT FORM PO Box 363, Trenton NJ 08625-0363 | 609-826-4869 . PATIENT INFORMATION . LAST NAME FIRST NAME MIDDLE INITIAL DATE OF BIRTH ADDRESS CITY STATE ZIP CODE TELEPHONE (indicate home, work orcell) SEX AT BIRTH Male Female . CURRENT GENDER
Use PDF (NEW!) for electronic AND hand-written completion. Word version contains instructions. (Contact Child & Adolescent Health Program at 609-292-5666 for more information.) New fillable PDF form! Word document no longer available.
We offer confidential STD screening, testing and education services at no cost to county residents. For more information call 609-265-5533. Burlington County Health Department 15 Pioneer Blvd., Westampton, NJ 08060. Masks are required. For patient safety and security, we require photo ID for all clinic clients.
The Atlantic County Division of Public Health offers confidential STD testing, treatment, counseling/education, HIV testing and PrEP referrals at no cost to county residents. The walk-in clinic is open every Monday (except holidays) 2:00-4:00PM at 201 S. Shore Road in Northfield.
