Get Dhhs4114 Form

Completing the Dhhs4114 Form online can seem daunting, but with clear guidance, you can efficiently fill out all necessary sections. This form is crucial for reporting HIV/AIDS cases and ensures that the relevant health information is accurately recorded for public health purposes.

Follow the steps to complete the Dhhs4114 Form online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by filling out the patient identification and demographics section. Provide the patient’s first name, middle name, last name, and any aliases. Make sure to include the current street address, city, state, ZIP code, phone number, date of birth, and any other demographic details requested.
3. Complete the marital status, race, and ethnicity fields. Check the box that applies to the patient’s vital status (alive or dead) and provide necessary details about the patient's country of birth.
4. Fill out the section regarding the source of report information, indicating which facility provided the information and include their contact details.
5. Enter HIV diagnosis information by specifying the facility of diagnosis, if it is the same as the reporting facility, and include relevant laboratory data regarding diagnostic tests.
6. Complete AIDS diagnosis information similarly to the HIV section, ensuring accurate reporting of all laboratory results and addresses at the time of diagnosis.
7. Provide clinical information, detailing any opportunistic infections or related diagnoses the patient may have.
8. Document the patient's history, including risks and any previous testing history. Be thorough in answering questions about potential exposure or previous diagnoses.
9. In the screening, counseling, and referrals section, provide details about any tests for TB or syphilis and mention any post-test counseling that occurred.
10. Finally, review all sections for accuracy and completeness. Once satisfied with the information provided, you can save changes, download, print, or share the completed form as needed.

Take the next step towards efficient document management by filling out the Dhhs4114 Form online today.