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.

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Created by: Team GoCanvas
Type: Reports
Language: English
Country: United States of America

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.

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