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Search results with tag "Confidential morbidity report"
LOS ANGELES COUNTY SEXUALLY TRANSMITTED DISEASE ...
www.publichealth.lacounty.govAug 24, 2011 · confidential morbidity report. report status: update. new. report done by: (first+space+last) p r o v i d e r. facility/clinic name facility/clinic street address city/town title abbreviation suite/unit no. state zip code.
Confidential Morbidity Report - Los Angeles County ...
publichealth.lacounty.govCOUNTY OF LOS ANGELES - DEPARTMENT OF PUBLIC HEALTH. CONFIDENTIAL MORBIDITY REPORT. Created: 4/14/08, Revised: Risk Factors / Suspected Exposure Type: (check all that apply) Race (check one): Ethnicity (check one): NOTE: This form is not intended for reporting STDs, HIV, AIDS or TB. See comments below. DISEASE BEING REPORTED: