This page contains Flash content. You need to upgrade your Flash Player.
You can do so by visiting Adobe.com.

Form Download

HIV EIS Forms
     Consent Form – Sample

     Field Report Form - due each quarter

     OraSure Request Form

New HIV Test Form aka Bubble Sheet
     New Form-Part 1 and Part 2

     Instructions for New Form

     Test Form Disposal

     FIPS Codes-Nationa l

     Sample HIV Positive Confidential Case Report Form

Instructions and How to Obtain Case Report Form

Rapid HIV Testing
     Clearview Request Form

     CLIA Waiver - Application & Instructions

     CLIA Waiver Application - Where to Send

Georgia HIV and STD Laws

HIV Test Result Log

Policy, Procedures, and Quality Assurance Plan - Template

Refrigerator Temperature Log

Supplies & Equipment

Thermometer - Minimum, Maximum

Links to Resources:

Forms:

Want a CLIA Waiver? Need rapid HIV testing P&P? Click here

Caution: This website contains HIV/AIDS-related messages that may be considered controversial by some viewers.

The HIV Early Intervention Services Program
is made possible by Federal Substance Abuse Prevention and Treatment Block Grant funds
set aside for the delivery of early intervention services for HIV.

HIV Early Intervention Services is a program of the Division of Addictive Diseases
Georgia Department of Behavioral Health and Developmental Disabilities

Coordination of the Georgia HIV EIS program is provided by Imagine Hope, Inc.