Shaded items represent questions from regular UDC registration form 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the CDC ID at the top of the form. This is essential for tracking and identification.
3. Fill in the 'Date of Visit' and 'Date Form Completed' fields accurately to ensure proper documentation.
4. In the 'DEMOGRAPHIC/REFERRAL INFORMATION' section, provide your month and year of birth, select your race/ethnicity, and indicate your place of birth.
5. For HTC status, choose from established, new, or transfer patient options as applicable.
6. Continue through each shaded item carefully, checking all relevant boxes and providing additional information where prompted.
7. Review all entries for accuracy before submitting to ensure that all necessary information is captured correctly.

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