Get APLA Physician Diagnosis Form
you do not have an answer to that particular question. Return to the AIDS Project Los Angeles Registrar by fax at 213.201.1392 or mail to: AIDS Project Los Angeles, The David Geffen Center, 611 South Kingsley Drive, Los Angeles, CA 90005. Last Name __________________________ First Name _____________________ Middle Name ______________ _ _ Date of Birth ________________________ Social Security No. DATE DIAGNOSIS: J J (Choose only one) J J HIV+ Asymptomatic (No Symptoms) AIDS Asymptomatic (N.
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