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STD Clinic Record (Female)


This is a STD history record form template used by the Broome County Health Department as a guide to document patient history for females who are being seen for the first time.

Primary Toolkit:

HIV/STI Toolkit

Keyword Area:

HIV/AIDS, Infectious Diseases, Surveillance


Institutional Author:

Broome County Health Department Clinic Services





The NACCHO Toolbox is a repository of available resources to help local public health practitioners. Tools are produced by local, state, and federal agencies, as well as academic institutions and other stakeholders. The contents of this Toolbox are solely the responsibility of the authors and do not necessarily reflect any official recommendations of NACCHO. NACCHO makes no express or implied warranty with respect to the contents and disclaims liability for any damages arising from or connected to the use of the material in this Toolbox.