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WEBSITE OF THE STATE OF SOUTH DAKOTA DEPARTMENT OF HEALTH
Kim Malsam-Rysdon, Secretary of Health
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South Dakota Confidential Disease Report
South Dakota Department of Health
Office of Disease Prevention
SDCL 34-22-12
and
ARSD 44:20
Reportable Disease List
Instructions:
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Note: Fields with an asterisk(*) are required.
Other disease reporting options:
Phone:
1-800-592-1861 or 605-773-3737 for a disease surveillance person during normal business hours
Fax: 605-773-5509
Outbreak Report
Weekly Influenza Report
Patient Information
Report Type:
New
Update
Report Date:
1/27/2021
*
Last Name:
*
First Name:
Middle:
Street Address:
Mailing Address:
(if different from Street)
Zip:
*
City:
State:
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AK
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CA
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CT
DC
DE
FL
GA
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HI
IA
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KY
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MS
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NE
NH
NJ
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NY
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OK
OR
PA
PR
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SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
County:
- - Select - -
AURORA
BEADLE
BENNETT
BON HOMME
BROOKINGS
BROWN
BRULE
BUFFALO
BUTTE
CAMPBELL
CHARLES MIX
CLARK
CLAY
CODINGTON
CORSON
CUSTER
DAVISON
DAY
DEUEL
DEWEY
DOUGLAS
EDMUNDS
FALL RIVER
FAULK
GRANT
GREGORY
HAAKON
HAMLIN
HAND
HANSON
HARDING
HUGHES
HUTCHINSON
HYDE
JACKSON
JERAULD
JONES
KINGSBURY
LAKE
LAWRENCE
LINCOLN
LYMAN
MCCOOK
MCPHERSON
MARSHALL
MEADE
MELLETTE
MINER
MINNEHAHA
MOODY
OGLALA LAKOTA
OUT-OF-STATE
PENNINGTON
PERKINS
POTTER
ROBERTS
SANBORN
SPINK
STANLEY
SULLY
TODD
TRIPP
TURNER
UNION
WALWORTH
YANKTON
ZIEBACH
Home Phone:
Other Phone:
Work
Cell
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Race:
- - Select - -
White
Black or African American
American Indian or Alaska Native
Asian
Hawaiian or Other Pacific Islander
Other Race
Unknown
*
Ethnicity:
- - Select - -
Hispanic or Latino
Not Hispanic or Latino
Unknown
Occupation:
*
Date of Birth:
(mm/dd/yyyy)
*
Gender:
- - Select - -
Male
Female
Email Address:
Disease Information
*
Disease or Condition:
- - Select - - Category I Diseases are in RED, Category II Diseases are in BLUE
*Anthrax (Bacillus anthracis)
Arboviral encephalitis, meningitis and infection (California serotype)
Arboviral encephalitis, meningitis and infection (Chikungunya)
Arboviral encephalitis, meningitis and infection (Colorado tick fever)
Arboviral encephalitis, meningitis and infection (Eastern equine)
Arboviral encephalitis, meningitis and infection (Japanese)
Arboviral encephalitis, meningitis and infection (LaCrosse)
Arboviral encephalitis, meningitis and infection (Powassan)
Arboviral encephalitis, meningitis and infection (St Louis)
Arboviral encephalitis, meningitis and infection (West Nile virus)
Arboviral encephalitis, meningitis and infection (Western equine)
Arboviral encephalitis, meningitis and infection (Zika virus)
Babesiosis (Babesia spp.)
*Botulism (Clostridium botulinum)
*Brucellosis (Brucella spp.)
Campylobacteriosis (Campylobacter spp.)
Carbon monoxide poisoning
Chancroid (Haemophilus ducreyi)
Chickenpox/Varicella (Herpesvirus)
Chlamydia infections (Chlamydia trachomatis)
Cholera (Vibrio cholerae)
Coccidioidomycosis (Coccidioides spp.)
*Coronavirus Disease 2019 (COVID-19)
CRE (Carbapenem-resistant Enterobacteriaceae)
Cryptosporidiosis (Cryptosporidium parvum)
Cyclospora (Cyclospora cayetanesis)
Dengue Fever (Flavivirus)
*Diphtheria (Corynebacterium diphtheriae)
Drug resistant organisms: Drug resistant Streptococcus pneumoniae (DRSP), invasive
Drug resistant organisms: Methicillin-resistant Staphylococcus aureus (MRSA), invasive
Drug resistant organisms: Vancomycin-intermediate Staphylococcus aureus(VISA)
Drug resistant organisms: Vancomycin-resistant Staphylococcus aureus(VRSA)
Ehrlichiosis (Ehrlichia spp.)/Anaplasmosis (Anaplasma spp.)
Giardiasis (Giardia lamblia/intestinalis)
Gonorrhea (Neisseria gonorrhoeae)
Haemophilus influenzae, invasive
Hantavirus pulmonary infection (Hantavirus)
Hantavirus pulmonary syndrome (Hantavirus)
Hemolytic uremic syndrome
Hepatitis A, Acute
Hepatitis B infection, perinatal
Hepatitis B, Acute
Hepatitis B, Chronic
Hepatitis C, Acute
Hepatitis C, Chronic
Human immunodeficiency virus infection (HIV)
Influenza: Hospitalization
Influenza: Death (Any age)
Influenza: Laboratory confirmed case (Culture, DFA, or PCR)
*Influenza: NOVEL strain
Lead, elevated blood levels
Legionellosis (Legionella spp.)
Leprosy/Hansen's disease (Mycobacterium leprae)
Leptospirosis (Leptospira)
Listeriosis (Listeria monocytogenes)
Lyme disease (Borrelia burgdorferi)
Malaria (Plasmodium spp.)
*Measles (Paramyxovirus)
*Meningococcal disease, invasive (Neisseria meningitidis)
*Middle East respiratory syndrome, MERS (Coronavirus)
Mumps
Other, Not Listed
*Outbreaks: Acute upper respiratory illness
*Outbreaks: Diarrheal disease
*Outbreaks: Foodborne disease
*Outbreaks: Healthcare-associated infections
*Outbreaks: Illnesses in child care settings
*Outbreaks: Rash illness
*Outbreaks: Waterborne disease
Pertussis (Bordetella pertussis)
Pesticide-related illness, acute
Pesticide-related injury, acute
*Plague (Yersina pestis)
*Poliomyelitis (Picornavirus)
Psittacosis (Chlamydia psittaci)
Q fever (Coxiella burnetii)
*Rabies animal (Rhabdovirus)
*Rabies human (Rhabdovirus)
Reference Lab Report Only
Rocky Mountain spotted fever (Rickettsia rickettsii)
*Rubella syndrome
*Rubella syndrome, congenital
Salmonellosis (Salmonella spp.)
*Severe Acute Respiratory Syndrome, SARS (Coronavirus)
*Shiga-toxin positive Escherichia coli (STEC),includes E. coli 0157:H7
Shigellosis (Shigella spp.)
Silicosis
*Smallpox (Variola)
Streptococcus pneumoniae, invasive all
*Syndromes suggestive of bioterrorism and other public health threats
Syphilis (Treponema pallidum)
Tetanus (Clostridium tetani)
Toxic shock syndrome
Transmissible spongiform encephalopathies
Trichinosis (Trichinella spiralis)
*Tuberculosis (Mycobacterium tuberculosis or bovis): Active disease
Tuberculosis (Mycobacterium tuberculosis or bovis): Latent infection
*Tularemia (Francisella tularensis)
Typhoid (Salmonella typhi)
Typhus fever (Rickettsia prowazekii)
*Unexplained illnesses or deaths in humans or animals
Vaccine Adverse Events
Vibriosis (Vibrionaceae)
*Viral Hemorrhagic Fever (arenavirus, filovirus)
*Yellow fever (Flavivirus)
Date of Onset:
(mm/dd/yyyy)
*
Lab Test Performed?
Yes
No
Name of Lab:
*
Lab Test Name:
- - Select - -
Antibody test for SARS-CoV-2 (includes IgM, IgG, or IgA)
Antigen test for SARS-CoV-2
Other, Not Listed
RNA PCR test for SARS-CoV-2 (includes Abbott ID NOW)
Specify Other Test Name:
*
Specimen Source:
*
Date Collected:
(mm/dd/yyyy)
*
Lab Test Result:
Lab Report Date:
(mm/dd/yyyy)
*
Facility Ordering Test:
*
Was Patient Hospitalized?
Yes
No
Date Admitted:
(mm/dd/yyyy)
Name of Hospital:
Date Discharged:
(mm/dd/yyyy)
Hospital Address:
Hospital Phone:
Outcome:
Survived
Expired
*
Date of Death:
(mm/dd/yyyy)
Specimen Ship Date:
(mm/dd/yyyy)
Specimen Estimated Arrival:
(mm/dd/yyyy)
Shipping Comments
Treatment Information
Was this person treated?
Yes
No
Unknown
Treatment Provided:
Treatment Dosage:
Treatment Duration:
Treatment Date Initiated:
(mm/dd/yyyy)
*
Date Collected:
(mm/dd/yyyy)
*
Specimen Source:
*
Lab Test Name:
*
Lab Test Result:
Name of Lab:
Lab Report Date:
(mm/dd/yyyy)
*
Facility Ordering Test:
Clinical & Treatment Information
Was this person symptomatic?
Yes
No
Date of Onset:
(mm/dd/yyyy)
Duration of Symptoms:
(days)
Estimate Date of Last Sexual Exposure:
(mm/dd/yyyy)
Was this person treated?
Yes
No
Treatment Provided:
- - Select - -
Azithromycin 1 GM PO
Azithromycin 2 GM PO
Cefixime 400 mg PO
Ceftriaxone 125 mg IM
Ceftriaxone 250 mg IM
Doxcycline
Bicillin L-A 2.4 mu/week x 3 weeks
Bicillin L-A 2.4 mu IM
Other
Treatment Date Initiated:
(mm/dd/yyyy)
Other Treatment:
Pregnant?
Yes
No
Weeks Pregnant:
Tested for HIV?
Yes
No
Date:
(mm/dd/yyyy)
HIV Test Results:
Positive/Reactive
Negative
Non-Reactive
Indeterminate
Invalid
No Result
Attending Health Care Provider
First Name:
Last Name:
Suffix:
Phone:
Ext:
Comments:
Person Reporting
*
First Name:
*
Last Name:
Suffix:
*
Phone:
Ext:
Email:
*
Facility Name:
- - Select - -
Abbott House
Aberdeen Family Physicians
Aberdeen Health & Rehab
Aberdeen VA Clinic
Ability Building Services
Acute Care 26th and Sycamore
Alandy Medical Clinic Eureka
Alcester Medical Clinic
Angelhaus
Angelhaus - East
Angelhaus - North
Angelhaus - West
Angelhaus - Yankton
Any Lab Test Now
Arlington Medical Clinic
Armour Clinic
Aurora County Clinic Plankinton
Avantara Armour
Avantara Clark
Avantara Huron
Avantara Lake Norden
Avantara Milbank
Avantara Mountain View
Avantara North - Rapid City
Avantara Norton
Avantara Pierre
Avantara Redfield
Avantara Salem
Avantara Watertown
Aventara Saint Cloud- Rapid City
Avera Aberdeen Pediatrics
Avera Behavioral Health Center - Sioux Falls
Avera Brady Health and Rehab Mitchell
Avera Brookings Medical Clinic
Avera Clinic of Groton
Avera Corsica Medical Clinic
Avera Dells Area Hospital - Dell Rapids
Avera Gregory Hospital
Avera Hand County Memorial Hospital - Miller
Avera Harrisburg Medical Clinic
Avera Heart Hospital of South Dakota - Sioux Falls
Avera Mary House, Pierre
Avera McKennan Healthcare Clinic Sioux Falls
Avera McKennan Hospital Sioux Falls
Avera Medical Associates Clinic Pierre
Avera Medical Group - Big Stone Clinic
Avera Medical Group - Olegario Clinic Mitchell
Avera Medical Group Gregory
Avera Medical Group Ipswich
Avera Milbank Area Hospital
Avera Mother Joseph Manor Aberdeen
Avera OB GYN Associates Sioux Falls
Avera Queen of Peace Hospital - Mitchell
Avera Quick Care (Kesslers)- Aberdeen
Avera Sacred Heart Hospital - Yankton
Avera Selby Clinic
Avera Sister James Care Center - Yankton
Avera Splitrock Clinic Garretson
Avera St Benedict Health Center - Parkston
Avera St Benedict Rural Health Clinic Lake Andes
Avera St Joseph Clinic Howard
Avera St Lukes Hospital - Aberdeen
Avera Tea Medical Clinic
Avera United Clinic Bowdle
Avera Westkota Memorial Medical Center Wessington Springs
Avera Wilmot Clinic
Avera Winner Medical Clinic
Bartron Clinic Watertown
Bell Medical Services DeSmet
Belyea Balvin Clinic Huron
Bennett County Healthcare Clinic Martin
Bennett County Hospital Martin
Berg Medical Clinic DeSmet
Bethany Home-Brandon
Bethel Lutheran Home
Bethesda Home Aberdeen
Bethesda Towne Square Asstd Living Aberdeen
Biotest Plasma Center- Brookings
Biotest Plasma Center-Vermillion
Bison Community Clinic
Black Hills Clinic Hot Springs
Black Hills Dialysis Pine Ridge
Black Hills Family Practice Rapid City
Black Hills Pediatrics Rapid City
Black Hills State University Student Health Center
Black Hills Surgery Center - Rapid City
Black Hills Urgent Care (Haines Location)
Black Hills Urgent Care (Mtn View Rd)
Black Hills Urgent Care Clinic Spearfish
Black Hills Urology, PC Rapid City
Bon Homme Family Practice Avon
Bon Homme Family Practice Tyndall
Bowdle Clinic
Bowdle Hospital
Brandon Valley School
Brookings Hospital
Brothers Pharmacy
Brown Clinic Watertown
Brown County Health Center Aberdeen
Bryant Clinic
Buffalo Community Health Center
Burke Medical Clinic
Campbell County Clinic Herreid
Canton Family Physicians
Center for Family Medicine Sioux Falls
Centerville Medical Clinic
Cheyenne River Sioux Tribal Health Eagle Butte
Childrens Care Hospital and School Sioux Falls
Clarkson Healthcare Rapid City
Clear Lake Medical Center
Colman Medical Clinic
Colton Medical Clinic
Community Health Center of the Black Hills
Community Health Clinic Elk Point
Community Memorial Hospital (Sanford) - Burke
Community Memorial Hospital - Redfield
Conklin, Richard MD Aberdeen
Coteau des Prairies Clinic Sisseton
Coteau des Prairies Hospital Sisseton
Creekside Medical Clinic Rapid City
Dakota Family Practice Mitchell
Dakota Hills Family Practice Sturgis
Dakota Sun Assisted Living
Dakota Womens Clinic Mitchell
Day County Medical Center Webster
Delaney Clinic Mitchell
DeSmet Community Health Center
DeSmet Memorial Hospital
Deuel County Good Samaritan Center Clear Lake
Disease Prevention Field Office Aberdeen
Disease Prevention Field Office Pierre
Disease Prevention Field Office Rapid City
Disease Prevention Field Office Sioux Falls
Disease Prevention Field Office Watertown
Doland Clinic
Douglas County Memorial Hospital - Armour
Dow Rummel Village
Dunes Family Medicine North Sioux City
Eastern Star Home
Edgemont Memorial Clinic
Edgewood Assisted Living - Mitchell
Edgewood Prairie Crossings Watertown AL, LLC
Edgewood Prairie Crossings Watertown AL, LLC
Edgewood Senior Living LLC Pierre
Edgewood Sioux Falls Senior Living
Edgewood Spearfish Senior Living, LLC
Elk Point Community Health
Elkton Health Center
Ellsworth Air Force Base
Estelline Community Hospital
Eureka Community Hospital
Eureka Medical Clinic
Faith Community Health Center
Fall River Health Services Hot Springs
Falls Community Health
Family Care Rapid City
Family Health Center Eagle Butte
Family Health Clinic Hot Springs
Family Healthcare of Siouxland
Family Healthcare of Siouxland Dakota Dunes
Family Medical Center Mitchell
Family Medical Center Spearfish
Family Medical Center Sturgis
Family Medicine Clinic Yankton
Family Planning Brookings
Family Planning Deadwood
Family Planning Lead
Family Planning Mitchell
Family Planning Pierre
Family Planning Spearfish
Family Planning Vermillion
Family Planning Watertown
Family Planning Yankton
Family Practice Health South Rapid City
Family Practice Medical Center Beresford
Faulkton Area Medical Center
Faulkton Medical Clinic
Faulkton Senior Living
Firesteel Healthcare Center Mitchell
Five Counties Hospital - Lemmon
Flandreau Medical Center (Avera)
Flandreau Santee Sioux Tribal Clinic
Foothills Family Clinic Rapid City
Foothills Family Practice Black Hawk
Fort Meade VA Medical Center
Fountain Springs Healthcare Rapid City
Freeman Regional Health Services
Geddes Medical Clinic
Gettysburg Memorial Hospital
Golden Living Armour (LTC)
Golden Living Lake Norden (LTC)
Good Samaritan Society New Underwood (LTC)
Good Samaritan Society Tripp (LTC)
Good Samaritan Society Corsica
Good Samaritan Society Luther Manor Sioux Falls
Good Samaritan Society Prairie Creek Assisted Living
Good Samaritan Society Scotland
Good Samaritan Society- Miller
Good Samaritan Society: Canisota
Good Samaritan Society: Lennox
Good Samaritan Village Sioux Falls
Grand Living on Lake Lorraine
Hand County Clinic Miller
Hand County Memorial Hospital Miller
Hans P. Peterson Memorial Hospital - Philip
Harding County Clinic Buffalo
Health Concepts Rapid City
Highmore Health
Hoek, Jill PA Health Services DeSmet
Holiday Hills Estates Independent Living Rapid City
Hosmer Medical Clinic
Hot Springs VA Medical Center
Hoven Medical Clinic
Howard Clinic
Howard Community Health Center
Huron Clinic
Huron Clinic Pediatrics
Huron Quick Care
Huron Regional Medical Center
Indian Health Services Eagle Butte
Indian Health Services Fort Thompson
Indian Health Services Lower Brule
Indian Health Services McLaughlin
Indian Health Services Pine Ridge
Indian Health Services Rosebud
Indian Health Services Sioux San Rapid City
Indian Health Services Sisseton
Indian Health Services Wagner
Interlakes Medical Center Madison
Internal Medicine Associates Aberdeen
Internal Medicine Group Rapid City
Isabel Clinic
James Valley Community Health Center Huron
Jellesma Rural Health Clinic Clear Lake
Jenkins Living Center
Jerauld County Clinic Wessington Springs
Jones County Clinic Murdo
Juvenile Services Center Rapid City
Kadoka Clinic
Kadoka Nursing Home
Kass Clinic Rosholt
Keystone Treatment Center
Kimball Medical Clinic
Kyle Health Center
Lake Andes Senior Living
Lake Area Family Health Webster
Lake Area Hospital Webster
Lake County Detention Center
Lake Preston Clinic
Landmann-Jungman Memorial Hospital - Scotland
Lead Deadwood Regional Hospital
Lemmon Clinic
Lennox Area Medical Center
Lennox Assisted and Independent Living
Lennox School District
Lewis and Clark Family Medicine Clinic Yankton
Lewis and Clark Specialty Hospital - Yankton
LifeServe Blood Center
Lookout Memorial Hospital - Spearfish
Lyman County Health Center Kennebec
Madison Community Hospital - Madison
Malters and Malters Mitchell
Marion Assisted Living Center - Marion
Marshall County Healthcare Center Britton
Marshall County Medical Clinic Britton
Massa Berry Clinic Sturgis
McGreevy Clinic Avera Brandon
McGreevy Clinic Avera Salem
McGreevy Clinic Avera Sioux Falls
McGreevy Clinic Southeast Avera Sioux Falls
McGreevy Clinic West Avera Sioux Falls
McIntosh Clinic
Medical Arts Clinic Rapid City
Medical Arts Clinic Spearfish
Medical Arts West Hills-Rapid City
Medical Associates of the Black Hills Rapid City
Mellette County Clinic White River
Menno Clinic
Menno Olivet Care Center
Mercy Medical Center Sioux City IA
Michael J. Fitzmaurice State Veterans Home - Hot Springs
Mid Dakota Clinic Kennebec
Mid Dakota Clinic Oacoma
Mid Dakota Medical Center Chamberlain
Mike Durfee State Prison Springfield
Milbank Medical Center
Miller School District
Minnehaha County Jail Sioux Falls
Minnekahta Medical Clinic Hot Springs
Mission Medical Clinic
Mitchell Clinic
Mobridge Medical Clinic
Mobridge Regional Hospital
Monument Health Custer Hospital
Monument Health Lead-Deadwood Hospital
Monument Health Medical Clinic, Buffalo
Monument Health Medical Clinic, Hot Springs
Monument Health Sturgis Hospital
Monument Health Assisted Living: Custer
Monument Health Hospital Family Practice Residency
Monument Health Medical Clinic (Queen City) 10th St
Monument Health Medical Clinic Flormann St, Rapid City
Monument Health Medical Clinic, Belle Fourche
Monument Health Medical Clinic, Charles St, Lead-Deadwood
Monument Health Medical Clinic, Custer
Monument Health Medical Clinic, Hill City
Monument Health Medical Clinic, Junction Ave, Sturgis
Monument Health Medical Clinic, North Ave, Spearfish
Monument Health Medical Clinic, Wall
Monument Health Spearfish Hospital
Monument Health Sturgis Care Center
Monument Health Urgent Care Services, School of Mines, Rapid City
Monument Health Urgent Care, Jackson Blvd Rapid City
Monument Health Urgent Care, Lacrosse St, Rapid City
Monument Health Urgent Care-North
Monument Health Urgent Care-West
Monument Health West Center for Behavioral Health
Monument Hospital Rapid City
Monument l Health Family Medicine Clinic Rapid City
Mountainside Family Practice Rapid City
Mountainside Family Practice Spearfish
Nebraska Health and Human Services System
Newell Family Medical Center
North Central Hematology and Oncology Sioux Falls
North Dakota Department of Health
Northern Hills General Hospital - Deadwood
Northern State University Student Health Center
Northland Family Practice Madison
Northridge Clinic Watertown
Oahe Valley Health Center Fort Pierre
OB GYN Associates Aberdeen
OB GYN Associates Rapid City
OB GYN Limited Sioux Falls
OBGYN Specialty Clinic Sioux Falls
Olson Medical Clinic Vermillion
Onida Clinic
Ortonville Area Health Services
Other, not listed
Oyate Health Center Rapid City
Parker Area Medical Clinic
Parkview Care Center Bryant
Peaceful Pines Senior Living Community
Pediatrics Plus Mitchell
Pennington County Jail
Philip Clinic
Philip Nursing Home
Physicians Plaza Aberdeen
Piedmont Medical Center
Pine Lane Estates Assisted Living Yankton
Pioneer Memorial Hospital (Sanford) - Viborg
Planned Parenthood Rapid City
Planned Parenthood Sioux Falls
Platte Community Hospital
Platte Family Medical Clinic
Platte Health Center Avera
Pollock Clinic
Porcupine Clinic
Prairie Clinic Mobridge
Prairie Community Clinic Isabel
Prairie Estates Care Center: Elk Point
Prairie Health Clinic Armour
Prairie Heights Healthcare - Aberdeen
Prairie Home Assisted Living Yankton
Prairie Lakes Healthcare Center - Watertown
Prairie View Healthcare Center
Quality Health Clinic PLLC Yankton
Queen City Medical Spearfish
Quick Care Watertown
Ramos Clinic Scotland
Rapid Care Rapid City
Rapid City Medical Center
Rapid City Medical Center Downtown
Rapid City Medical Center Family Medicine Westside
Redfield Clinic
Revillo Clinic
Richardson Family Medicine Sioux Falls
Riverview Healthcare Center: Flandreau
Rolling Hills Healthcare - Belle Fourche
Roscoe Family Care Center
Rosebud Family Clinic Gregory
Rural Medical Clinic Bridgewater
Rural Medical Clinic Freeman
Rural Medical Clinic Marion
Rushmore Clinic Rapid City
Salem Family Medical Clinic
Same Day Surgery Center - Rapid City
Sandstone Senior Living
Sanford Aberdeen Medical Center
Sanford Acute Care Brookings
Sanford Acute Care Minnesota Avenue Sioux Falls
Sanford Canby Medical Center
Sanford Canby Medical Clinic
Sanford Cancer Center - Sioux Falls
Sanford Childrens Clinic - Mitchell
Sanford Childrens Clinic Aberdeen
Sanford Childrens Clinic MB2
Sanford Childrens Specialty Clinic Sioux Falls
Sanford Clinic Acute Care West
Sanford Clinic 26th and Sycamore - Sioux Falls
Sanford Clinic 69th and Minnesota
Sanford Clinic Aberdeen
Sanford Clinic Acute Care 41st
Sanford Clinic Adult Medicine - Sioux Falls
Sanford Clinic Beresford
Sanford Clinic Brandon
Sanford Clinic Brookings
Sanford Clinic Chamberlain
Sanford Clinic Clark
Sanford Clinic Downtown Women's Healthcare Sioux Falls
Sanford Clinic Estelline
Sanford Clinic Family Medicine 34th and Kiwanis
Sanford Clinic Family Medicine 49th
Sanford Clinic Family Medicine Huron
Sanford Clinic Family Practice and Acute Care West Sioux Falls
Sanford Clinic Gastroenterology Sioux Falls
Sanford Clinic Harrisburg
Sanford Clinic Internal Medicine Sioux Falls
Sanford Clinic Lake Norden
Sanford Clinic Medical Arts Sioux Falls
Sanford Clinic OB GYN LTD Sioux Falls
Sanford Clinic OB GYN Sioux Falls
Sanford Clinic Pediatrics East Sioux Falls
Sanford Clinic Pierre
Sanford Clinic Vermillion
Sanford Clinic Volga
Sanford Clinic Watertown
Sanford Clinic West 41st Street
Sanford Clinical Laboratories Sioux Falls
Sanford Family Health Clinic 41st and Sertoma - Sioux Falls
Sanford Hartford Clinic
Sanford Health : Fargo, ND
Sanford Health Stevens Center Walk-in-Clinic - Sioux Falls
Sanford Hospital Canton - Inwood
Sanford Hospital Chamberlain
Sanford Medical Center Sioux Falls
Sanford Medical Center - Clear Lake
Sanford Occupational Medicine and Walk-in Clinic Sioux Falls
Sanford USD Physicians Sioux Falls
Sanford Vermillion Care Center
Sanford Vermillion Hospital
Sanford Vermillion Medical Center
Sanford Vermillion USD Student Health Center
Sanford Webster Medical Center
Sanford Women's Health Plaza - Sioux Falls
Schramm Medical Clinic Winner
Scotland Medical Clinic
Selby Family Medical Center
Select Specialty Hospital Sioux Falls
SESDAC, INC Vermillion
Sioux Falls School District
Sioux Falls Surgical Center
Sioux Falls Urgent Care
Sioux Falls VA Medical Center
Siouxland Oral and Maxillofacial Surgery
Siouxland Surgery Center - Dakota Dunes
Sixth Avenue Family Practice Mitchell
Somerset Court Independent Retirement and Assisted Living
South Dakota Developmental Center Redfield
South Dakota Human Services Center Yankton
South Dakota Lions Eye Bank
South Dakota Public Health Laboratory Pierre
South Dakota State Penitentiary Health Services Sioux Falls
South Dakota State University Student Health Center
South Dakota State Womens Prison Pierre
South Dakota Unified Judicial System
South Dakota Urban Indian Health Aberdeen
South Dakota Urban Indian Health Pierre
South Dakota Urban Indian Health Sioux Falls
Southern Hills Family Medical Center Hot Springs
Spearfish Regional Medical Clinic- East Location
Spearfish Surgery Center
Spectra Labs Inc
Springfield Family Clinic
St Marys Healthcare Center - Pierre
St Michaels Hospital Tyndall
St Williams Care Center
St. Joseph Indian School Chamberlain
Stanley Jones Memorial Clinic Presho
Star Academy Custer
Stoneybrook Suites Assisted Living Huron
Sun Dial Manol-Bristol
Sunquest Healthcare Center Huron
Sunset Manor: Irene
Surgical Consultants, LTD Madison
Talecris Plasma Resources Sioux Falls
The Center Sioux Falls
The Inn on Westport
The Women's Center for Life Sioux Falls
The Womens Center for Life Huron
Tieszen Memorial Home-Marion
Touchmark at All Saints
Trailridge Retirement Community
Tschetter Hohm Clinic Huron
Tyndall Good Samaritan Center
United Blood Services
United Migrant Opportunity Services Sioux Falls
United Retirement Center Brookings
University of South Dakota Medical Center - Sioux Falls
University Physicians Canistota
University Physicians Sioux Falls
Urological Clinic Rapid City
Urology Specialists
US Public Health Service Indian Hospital - Eagle Butte
US Public Health Service Indian Hospital - Rosebud
USD School of Medicine Clinical Virology Laboratory Rapid City
USD School of Medicine Clinical Virology Laboratory Sioux Falls
VA Black Hills Health Care System - Fort Meade
VA Black Hills Health Care System - Hot Springs
Vermillion Medical Clinic
Viborg Medical Clinic LTD
Village at Skyline Pines
Volunteers of America Eagle Butte
Wagner Community Memorial Hospital (Avera)
Wakonda Heritage Manor
Wall Health Services - Sioux Falls
Walworth County Healthcare
Wanblee Health Center
Watertown Quick Care
Waubay Clinic
West Dakota Health Center Timber Lake
West River Health Association McLaughlin
West River Regional Medical Center Hettinger
White Medical Clinic
White River Health Care
Whiting Memorial Clinic Woonsocket
Wilmot Care Center
Wilmot Clinic
Winner Regional Clinic
Winner Regional Healthcare Center
Womens Health and Education Aberdeen
Womens Health and Education Huron
Woodrow Wilson Keeble Memorial Health Care Center-Sisseton
Yankton Care Center
Yankton Community Health Center
Yankton Community Work Center
Yankton Federal Prison
Yankton Medical Clinic
Yankton Trustee Unit
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BEADLE
BENNETT
BON HOMME
BROOKINGS
BROWN
BRULE
BUFFALO
BUTTE
CAMPBELL
CHARLES MIX
CLARK
CLAY
CODINGTON
CORSON
CUSTER
DAVISON
DAY
DEUEL
DEWEY
DOUGLAS
EDMUNDS
FALL RIVER
FAULK
GRANT
GREGORY
HAAKON
HAMLIN
HAND
HANSON
HARDING
HUGHES
HUTCHINSON
HYDE
JACKSON
JERAULD
JONES
KINGSBURY
LAKE
LAWRENCE
LINCOLN
LYMAN
MCCOOK
MCPHERSON
MARSHALL
MEADE
MELLETTE
MINER
MINNEHAHA
MOODY
OGLALA LAKOTA
OUT-OF-STATE
PENNINGTON
PERKINS
POTTER
ROBERTS
SANBORN
SPINK
STANLEY
SULLY
TODD
TRIPP
TURNER
UNION
WALWORTH
YANKTON
ZIEBACH
Home Phone:
Other Phone:
Work
Cell
Race:
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White
Black or African American
American Indian or Alaska Native
Asian
Hawaiian or Other Pacific Islander
Other Race
Unknown
Ethnicity:
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Hispanic or Latino
Not Hispanic or Latino
Unknown
Occupation:
Date of Birth:
(mm/dd/yyyy)
Gender:
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Male
Female
Transsexual
Other
Unknown
Email Address:
Estimated Date of Last Exposure:
(mm/dd/yyyy)
Did this partner present for follow-up?
Yes
No
Did partner receive Partner Delivered Therapy (PDT)?
Yes
No
Was partner tested?
Yes
No
Results:
Date Collected:
(mm/dd/yyyy)
Was partner treated?
Yes
No
Treatment Provided:
- - Select - -
Azithromycin 1 GM PO
Azithromycin 2 GM PO
Cefixime 400 mg PO
Ceftriaxone 125 mg IM
Ceftriaxone 250 mg IM
Doxcycline
Bicillin L-A 2.4 mu/week x 3 weeks
Bicillin L-A 2.4 mu IM
Other
Treatment Date:
(mm/dd/yyyy)
Other Treatment:
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