Get Hiv Client Intake Form

Filling out the Hiv Client Intake Form online is an essential step in accessing appropriate support and treatment. This guide provides clear instructions to help you complete each section of the form accurately and efficiently.

Follow the steps to effectively complete your intake form.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin the form by answering question 1.b, which asks about your frequency of injecting drugs with a needle in the last six months. Use the provided options on Answer Card B to respond.
3. Continue to question 2 regarding the use of dirty needles or syringes. Again, utilize Answer Card B for your answer.
4. Proceed to question 3.b, which inquires about the usage of shared equipment such as cookers, cotton, or rinse water. Refer to Answer Card B to select your response.
5. Answer question 4 to detail the number of people with whom you shared works in the last six months. Enter the total number as instructed.
6. Move to question 5 to indicate how many times you injected drugs in the last 30 days before this treatment. Provide your answer using the relevant field.
7. For question 6, specify how many times you used dirty needles or syringes in the last 30 days. Fill in your response in the designated area.
8. Question 7 requires you to state the occurrences in which you used shared equipment during those 30 days. Input your answer as prompted.
9. Question 8 pertains to the number of times you injected drugs in the presence of others also injecting. Document your findings in the given space.
10. Conclude this section with question 9 by indicating how many people you have shared works with in the last 30 days.
11. Continue to question 10, focusing on your sexual activity in the last six months. Indicate the number of partners you had during this period.
12. For question 11, clarify how often you had sex without using a latex condom in various scenarios presented. Complete all parts a through c.
13. In question 12, answer how many people you had sex with in the last 30 days, including all types of sexual activity.
14. Question 13 inquires about the gender distribution of your partners in the last month. Fill in the number of female and male partners separately.
15. For question 14, provide the total number of times you had sex that month, excluding masturbation.
16. Question 15 asks for the occurrences of sex without a condom that month—be thorough in your response.
17. Finally, complete question 16 by detailing how many times various sexual encounters occurred without protection. Enter your responses for each category.
18. Proceed to question 17 to identify how many people you know who have been infected with the AIDS virus.
19. Answer question 18 regarding the frequency of your HIV testing. If you have tested before, additional prompts will follow.
20. For question 19.e, share your agreement level with various statements about AIDS risk. Use Answer Card E for guidance.
21. Review your responses before finalizing the form. You can then save, download, print, or share your completed intake form as needed.

Start filling out your Hiv Client Intake Form online today to secure the support you need.