Get Hiv Application Form - Child.pdf

Completing the HIV Application Form for a child can be an essential step in ensuring proper healthcare management. This guide will provide clear instructions on how to fill out the form efficiently and accurately.

Follow the steps to complete the application form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin with the 'Main Member Details' section. Fill in the main member's name, select their gender, and enter the ID number.
3. Proceed to the 'Child's Details' section. Enter the child's surname, first names, date of birth, and gender. Indicate the birth delivery method and province, along with the birth weight.
4. In the 'Mother's Details' section, provide the mother's first name, surname, and HIV status. If known, include the mother's antiretroviral history and the latest CD4 and viral load counts.
5. Next, complete the 'Guardian Details' section. Fill in the guardian's first name, surname, relationship to the child, date of birth, physical address, postal address, and contact numbers.
6. Fill in the 'Medical Aid Details' by entering the medical aid name, number, plan option, and dependent code.
7. Provide the 'Doctor's Details,' ensuring to fill in the name, practice number, qualification, address, and contact details. The examiner must sign in this section.
8. Review the section requiring the member’s signature, confirming their understanding of the requirements for registration and consent for treatment.
9. Complete the 'Medication Delivery Address' section by selecting the preferred delivery option and providing the necessary address details.
10. Fill in the 'Medical History' section, including the ICD 10 code, date of first HIV positive test, drug allergies, and chronic conditions.
11. In the 'Treatment Details' section, list any previous or current medications along with their respective dates.
12. Lastly, fill in the serological tests section, including all relevant laboratory tests and results.
13. After ensuring all required fields are completed, save your changes, and then choose to download, print, or share the form.

Take the first step in managing your child's health by completing the HIV Application Form online today.