OMB No. 0930-0343 Expiration Date: 09/30/2017 Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays.
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How to use or fill out the SAMHSA MAI Rapid HIV/HEPATITIS Testing Clinical Information Form - Integration Samhsa online
Filling out the SAMHSA MAI Rapid HIV/HEPATITIS Testing Clinical Information Form is an essential step in ensuring accurate and comprehensive health information is documented. This guide provides clear instructions on how to complete the form online effectively and efficiently.
Follow the steps to accurately fill out the form online.
- Press the ‘Get Form’ button to access the form and open it in the designated editor.
- Begin with Section A: Site Characteristics. Enter the date of visit, grantee number, client ID, partner ID if applicable, and the site type code.
- Proceed to Section B: Demographics. Here, indicate the gender, ethnicity, age, and previous testing information. Ensure to check the appropriate options.
- In Section C: Risk Behaviors, select any risk behaviors experienced in the last 30 days. Check all that apply regarding unprotected sex and substance use.
- Move to Section D: Rapid HIV Testing Results. Select the result of the rapid HIV test performed.
- Complete Section E: Rapid Hepatitis B & C Testing Results by checking the results of hepatitis tests conducted.
- Fill out Section F: Confirmatory Testing for HIV if the rapid HIV test result was positive.
- Continue to Section G: Confirmatory Testing for Hepatitis B & C if applicable, and provide the necessary results and type of confirmatory test.
- In Section H and Section I, check all services provided related to HIV and Hepatitis care.
- Finally, review all entered information for accuracy. Once finalized, save your changes, and choose to download, print, or share the completed form as needed.
Complete and submit your documents online to maintain accurate health records.
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