Get Dhs 8641a Form

The Dhs 8641a Form is an essential document for reporting adult HIV/AIDS cases. This guide provides clear and detailed instructions on how to complete this form online, ensuring that users can navigate each section with confidence and accuracy.

Follow the steps to effectively complete the Dhs 8641a Form online.

1. Press the ‘Get Form’ button to access the Dhs 8641a Form and open it in your preferred online editor.
2. Begin by entering the date the form is completed, including the month, day, and year.
3. Indicate the report status by selecting either 'New' or 'Update' and provide the reporting health department's patient number.
4. For HIV and AIDS cases, input the soundex code and the patient's date of birth, including the month, day, and year.
5. Select the patient's gender and provide the last four digits of the Social Security Number along with the lab report number.
6. Fill in the demographic information by checking the appropriate box for the diagnosis status, current status, and age at diagnosis.
7. Select the patient’s race/ethnicity from the provided options and include the state or territory of death if applicable.
8. Complete the patient's history section by selecting the relevant facility type and setting.
9. Respond to the categories regarding the patient's history with clear indications of yes, no, or unknown.
10. Input laboratory data, including the results of HIV antibody tests and viral load measures, specifying details as prompted.
11. Document the clinical status by indicating if the clinical record was reviewed and input the diagnosis information.
12. Finally, provide the provider information, including the physician's name, address, and contact information.
13. Once all fields are completed, save any changes, and proceed with options to download, print, or share your completed form.

Complete your Dhs 8641a Form online to ensure accurate and timely reporting of HIV/AIDS cases.