Follow the steps to fill out the ND Form SFN 59122 online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the facility information by providing the facility name and telephone number in the designated fields.
3. Complete the client information section, including the client's last name, first name, sex, and date of birth. Make sure to select the correct option for male or female.
4. Fill out the Chembio SURE CHECK® HIV 1/2 rapid assay results by entering the collection date and selecting the result status as either negative (nonreactive) or preliminary positive (reactive). If needed, indicate the scheduled return for confirmatory test results by providing the date and time.
5. Complete the confirmatory HIV test results section, documenting if the results are negative (nonreactive) or positive (reactive) along with the collection date.
6. For the OraQuick® HCV rapid antibody test results, input the collection date and the result status as negative (nonreactive) or preliminary positive (reactive). If applicable, provide the scheduled return date and time for confirmatory test results.
7. Fill in the confirmatory HCV results sections, detailing the results as negative (nonreactive) or positive (reactive) alongside the collection dates where necessary.
8. Document the confirmatory HCV - Hepatitis C RNA test results status and the collection date.
9. Securely sign and date the counselor's signature field, followed by the client's signature and date.
10. Utilize the notes section for any additional comments before finalizing the form.
11. After completing all sections, save your changes. You can also download, print, or share the completed form as needed.

Begin filling out the ND Form SFN 59122 online now to ensure accurate submission.