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Adult HIV Confidential Case Report Form - Illinois Perinatal HIV - hivpregnancyhotline

Adult HIV Confidential Case Report Form - Illinois Perinatal HIV - hivpregnancyhotline 2026

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The document is an Adult HIV Confidential Case Report Form used by the Illinois Department of Public Health. It collects comprehensive patient identification and demographic information, medical history, laboratory data, treatment referrals, and risk factors related to HIV infection. The form emphasizes confidentiality and is designed for health department use to track and manage HIV cases effectively.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Patient Identification section. Enter the patient's first, middle, and last names, along with any alternate name types. Ensure you select the correct address type and provide the current street address, city, county, state/country, and ZIP code.
Next, complete the Health Department Use Only section. This includes entering the date received at the health department and other identifiers as required.
Proceed to fill in the Patient Demographics section. Record details such as sex assigned at birth, date of birth, ethnicity, and race. Make sure to answer all questions accurately.
In the Laboratory Data section, document all relevant HIV test results including collection dates and results for each test performed.
Finally, review all sections for completeness before saving your work. Utilize our platform's features to sign and share the completed form securely.

Start using our platform today to efficiently complete your Adult HIV Confidential Case Report Form!

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Versions	Form popularity	Fillable & printable
2013	4 Satisfied (56 Votes)
2009	4 Satisfied (60 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is there a database to see if someone has HIV?

The National HIV Surveillance System (NHSS) is the primary source of HIV data for monitoring cases of HIV infection in the United States and 6 U.S. territories and freely associated states (American Samoa, Guam, Northern Mariana Islands, Puerto Rico, Republic of Palau, U.S. Islands).

How do I get a HIV report?

Types of HIV test blood test where a sample of blood is taken in a clinic and sent for testing in a laboratory. Results are usually available on the same day or within a few days. point of care test where a sample of saliva from your mouth or a small spot of blood from your finger is taken in a clinic.

Is there an HIV directory?

Search the Referral Link directoryThe American Academy of HIV Medicines Referral Link is a directory of health care providers specializing in HIV management and prevention across the country.

What are the confidentiality laws for HIV in Illinois?

A confidential HIV test does have your name on it. But the test result must be kept confidential, in ance with Illinois law. In other words, the test result with your name on it will end up in your medical records, but no one can see your records without legal authorization.

Can you check to see if someone has HIV?

A rapid antigen/antibody test done with blood from a finger stick can usually detect HIV 18 to 90 days after exposure. An antigen/antibody lab test using blood from a vein can usually detect HIV 18 to 45 days after exposure. A NAT can usually detect HIV 10 to 33 days after exposure.

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What is the Illinois Perinatal HIV prevention Act?

The Illinois Perinatal HIV Prevention Act mandates that all pregnant women be provided HIV counseling and offered HIV testing as early in their pregnancy as possible.

Is there a national registry for people with HIV?

National HIV Surveillance System (NHSS) Surveillance data: active data collection. The Centers for Disease Control and Prevention (CDC) collects, analyzes, and disseminates surveillance data on HIV infection and AIDS; these data are the nations source of timely information on the burden of HIV infection.