Adult HIV Confidential Report - Centers for Disease Control and Prevention

Form Template

Response in this case is voluntary for federal government purposes, but may be mandatory under state and local statutes.

5,000 Companies save time and money with GoCanvas

Lumen Logo Post Consumer Brands Logo Saluda Hill Landscapes Logo Te3co Logo Two Men and a Truck Logo VIP Lighting Logo

Your cooperation is necessary for the understanding and control of HIV. Information in CDC’s National HIV Surveillance System, that would permit identification of any individual on whom a record is maintained, is collected with a guarantee that it will be held in confidence, will be used only for the purposes stated in the assurance on file at the local health department, and will not otherwise be disclosed or released without the consent of the individual. Patient Identification, Facility Providing Information, Patient Demographics, Laboratory Data, Residence at Diagnosis are all included in this adult HIV confidential report.

Features
  • Submission Editing
  • Reference Data
  • Dispatch
Read More
Platforms
  • iPhone
  • iPad
  • Android
  • Windows
Read More
Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
Read More
*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

Connect with one of our experts today.

We’ll help you put together the right solution for your needs.

Contact Us